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jHomceopatbic (T\eMcal Society 

State of New York 







Proceedings of the Thirty-Fifth Semi-Annual Meeting, held at the 
Cataract House, Niagara Falls, N. Y., on the 7th and 

8th of September, 1886. 

The meeting was called to order by the President, Henry C 
Houghton, M, D., of New York City, who made a few felicitous 
remarks, calling attention to the pleasant surroundings, the grandeur 
of the location and the desirability of entering heartily into the spirit 
of the scientific work before the Society. 

The Kev. J. W. Brown, D. D., of St. Paul's Church, Buffalo, 
N. Y., opened the session with prayer. 

J. C. Nottingham, M. D., a delegate from the Homoeopathic Med- 
ical Society of the State of Michigan, being ' present, was cordially 
welcomed, and the privileges of the floor extended to him. 

On motion of Dr. Hasbrouck, the courtesies of the Society were 
tendered to all visiting physicians present. 

Drs. Wright, Paine and Hasbrouck were appointed the committee 
on credentials. 

The committee on credentials subsequently reported the following 
members, delegates and visitors present : 

Drs. H. M. Paine, Albany Co.; F. E. Murphy, Cayuga Co.; A. H. 
Babcock, Chautauqua Co.; Ermina C. Eddy, Sarah Eddy Thorn, 
.Chemung Co.; A. R. Wright, J. D. Heinemann, Geo. W. Lewis, Jr., 
Joseph W. Cook, S. N. Brayton, L. A. Bull, F. Park Lewis, Erie Co.; 
John L. Moffat, E. Hasbrouck, A. von der Liine, L. Safford Gillespie, 
Kings Co.; G. T. Borden, Livingston Co.; J. M. Lee, II. M. Dayfoot, 
Edwin II. Wolcott, Sarah I. Lee, W. P, Fowler, W. F. Clapp, Monroe 
Co.; Henry C. Houghton, Fred. S. Fulton, New York Co.; Fredk. 

v- 1 

4 Proceedings. 

Letur^nlut^er, < >noi<,H r °» A - J * Frantz, Seneca Co ; B. F. Grant, 
SftMiiI vn Co.: J. W.Coolidge, Scranton, Pa.; J. R. Simson, Tonawanda, 
N Y ; J«»Iiii<\ Nottingham, Bay City, Mich ; M. E. Sherman, Castile, 
N \ ; A. 4. Kvans, Lockport, X. Y.; J. W. Hodge, Niagara Falls, 

Uv.u' v ^»* from the societies of New York and Kings counties 
*% u usviwh! ivgarding the laws regulating the practice of medicine 
m V '\\ \ v»i k State. 

On moiioii, referred to the Committee on Legislation. 


Tlu; rh.iirman, T. F. Allen, M. D., being absent, the bureau report 
w.i.. pri'ni'iitiHl by Dr. E. II. Wolcott. 


Oia.n, McDowell, M. D., Chairman, being absent, Dr. Geo. W. 
Lk\u«. Ju., presented a paper on the "Bacillus of Typhoid Fever." 


K\ hiRi'rr IIasbrouck, M. D., Chairman. The following papers were 
nrt men ted : " Albuminuria of Pregnancy :" Its Causation, Dr. W. M. 
Ulackiimu ; Its Effects, Dr. Win. A. Allen; *Its Treatment, Dr. 
Uoorge W. Winterburn. 

" ( Complications of Parturition (Part II.), Pelvic Dystocia," Dr. II. 
J. Piorron. 

" A Perplexing Case of Parturition," Dr. R. C. Moffat. 

"The Use of Anaesthetics in Parturition," Dr. F. E. Murphy. 



Society convened at 3 p. m. First Vice-President, F. Park Lewis,' 
M. D., in the chair. The consideration of the report of the Bureau 
of Obstetrics was continued until 4:30 p. m., when the Society 
adjourned for the purpose of making a trip to Lew T iston. 

— • - - *-v title. 

Thirty-Fifth Semi-Annual Meeting. 


Society called to order at 8:30. First Vice-President, F. Park 
Lewis, M. D., in the chair. The President, Henry C. Houghton, 
M. D., delivered the following address on " The Medical Ethics of the 
Use and Abuse of Alcohol " : 

Members of the Homoeopathic Medical Society of the Stzte of 
New York : 

Ladies and Gentlemen : 

It is required of your presiding officer, that lie deliver at this time 
an address, and the unwritten law leads you to expect one of, a popular 
character, so if I fail to make it so in the ordinary sense, I have tried 
to make it so in a broader sense, for the theme touches every person 
present, every member of the society present or absent, every medical 
man or woman who stands between the living and the causes of death. 
My subject is, The Medical Ethics of the Use and Abuse of Alcohol. 

The praises of the wine cup have been sung in poetry and rung in 
prose, from the time that Noah succumbed to its seductive and 
voluptuous ecstacy. What was true then, is true now, and it is absurd 
to deny the plain fact, that this appeal to the senses is the secret of the 
hold which alcoholic beverages have upon the human race ; in it man 
has found stimulus to extraordinary effort, and temporary release 
from the ills of life, this stimulus, and this release, being secured by 
the risk of penalties which the genius of a Shakespeare fails to portray. 

What is use, and what is abuse in the consumption of alcohol ? . The 
right solution of the question involves interests that are most 
momentous. It affects not only the individual consumer, but bears 
upon community interests, menaces the peace of the State, and through 
the State the life of the Nation itself Twenty-five years ago we were 
confronted with a problem which involved the liberty of four millions 
of people, and the unity of this government ; two sections of the 
country faced each other in mortal combat, and for four years the 
world looked on, questioning the probable issue To day we are on 
the possible verge of a national struggle more liable to disintegrate the 
national body, because the forces are local, not sectional ; every labor 
interest, every investment of capital, all social and political issues, are 
involved, and may at any moment be dominated by forces well nigh 
irresistible. It is not my purpose to burden you with statistics ; but 
you will admit a few to show the possibilities of the future. 

6 Proceedings. 

By reference to the national returns it is seen that in 1873, 364,471,- 
672 gallons of alcoholic liquors were sold at a cost of $714,196,517 ; 
ten years later the amount rose to 610,195,505 gallons, at a cost of 
$944,629,531—69,000,000 increase in one year. *Gustafson gives the 
figures for the United Kingdom as over £130,000,000, and the expense 
and loss resulting from drink to be much more. What is the sig- 
nificance of these figures? Deduct the amount actually used in 
mechanical, chemical and medicinal arts, and we see that the great bulk 
of this wealth is consumed by our people as stimulating drinks. 

A careful student of the statistics of the census reports, Wm. Har- 
graves, M. D., says, during the present century (eighty-four years) we 
have spent for liquors $21,286,000,000, or $3,081,000,000 more than 
all foreign import during the same period, and $4,964,200,000, than all 
domestic exports. Thus have our people been continually spending, 
since the formation of the nation, more than the value of imports or 
exports ; similar comparisons may be drawn between assessed value of 
real and personal property, food products, results of mechanical 
industry, etc., all in favor of alcoholic products, and against the 
anarchist's cry that he is deprived of his labor. 

These figures may serve to prepare us for our second inquiry. What 
is the value of these products in the human economy ? This can only 
be answered by a study of its action. Alcohol is a narcotic stimulant, 
its action is similar to other agents of its kind, having its individual 
peculiarities, and this action must be studied under two heads. First, 
physiological; second, pathological. If by physiological we understand 
such action as is not characterized by abnormal phenomena or perma- 
nent tissue change, it must be admitted that this sphere of action must 
be very limited, for it is true that while some subjects may use large 
quantities of alcohol without apparant injury, others are seriously 
affected by very small amounts ; hence the ground where physiology 
shades into pathology is more or less undefined. 

Like other ethereal compounds such as chloroform, sulphuric ether, 
amyl-nitrate, etc., or like vegetable narcotics, the action of alcohol 
may be studied in two stages, excitation and depression, and it will be 
found that the axiom " action and re-action are equal and in opposite 
directions v holds true as in natural philosophy. Immediately after 
the ingestion of alcohol the phenomena of excitation begin, and are 
more or less marked in character, or prolonged in duration, according 

*Gustafson, Alex. Foundation of Death, London, 1884; Boston, 1885. I am indebted to 
this author for a research which it was impossible for me to make in the time at ray disposal. 
His bibliography on the subject is the most complete, and his work the most comprehensive 
and impartial, that I have ever had in hand. 

Thirty-Fifth Semi-Annual Meeting. 7 

to the form of liquor used : this action is primary, immediate, upon 
the great nervous centres, so prompt that some claim that it is due to 
inhalation, or direct transmission into the systemic circulation. The 
action is also secondary, indirect, by digestive and assimilative pro- 
cesses : its effects extend to every organ of the body. It is not my 
purpose to enlarge upon this well-known subject : suffice it to say that 
the various functions of the body are all involved, and are for the time 
apparently more active. If the dose is not repeated the effects 
gradually cease, and the ordinary functional conditions are resumed ; 
if the dose is repeated it is soon observed that in order to obtain all 
the marked symptoms of stimulation, as promptly as at the first, the 
dose must be increased : this is so until we are on the debatable ground 
of pathology. 

Without stopping to debate the mooted question, Is stimulation 
simply a fine shade of the later narcosis and paralysis ? or to inquire 
into the why or the how of the symptoms noticed under a limited use 
of alcohol, let us hasten to what more nearly concerns us. 

The pathological results of alcohol are now well recognized by us ; 
so there is little difference of opinion as to the relations of the cause 
and effect. Life is the resultant of two processes : constructive and 
destructive metamorphosis ; if either ceases, death ends all, first locally, 
then generally ; hence we may follow these two lines, and consider 
those functions which furnish building material, and those which 
remove the waste. The digestive and respiratory functions may stand 
for the first; the functions of the liver, kidneys, skin and the ex- 
cretory acts of the lungs, for the second, aided by muscular action, and 
presided over by the cerebro-spinal and sympathetic system. The acts 
of assimilation and circulation, are the connecting links between supply 
on one hand, and waste on the other, the tissues of the body constitute 
the field where the issues of life are waged. 

The apparent conflict of facts in gastric digestion, when alcohol is 
given, were explained by Dr. Beaumont in his experiments on St. 
Martin : the increased activity, sense of warmth and comfort, are due 
to the hyperemia caused by the alcohol. The later retarded digestion, 
is due to the precipitation of the peptin ferment. 

It is surprising to note the amount of derangement, even to ex- 
travasation that may occur, and very little discomfort be manifested 
by the subject. 

There is one gastric symptom that has been the cause of popular 
misconception, because it is systemic, rather than gastric : I mean the 
intense thirst caused bv alcohol. Even Mrs. Partington misunderstood 

8 Proceedings. 

Ike's condition and insisted that he never took anything to drink when 
he was out late at night, because he was so very thirsty the next 
morning. Alcohol has great affinity for water, and undiluted, will take 
it from the fluids of the mouth or stomach ; later, when carried into 
the general circulation, the draft is on the water in the tissues : hence 
the demand we call thirst ; it is puerile to claim that such outcry is a 
demand for alcoholic stimulant ; exhaustion may have made the first 
call for stimulant ; the second call is equally unnatural. 

Similar derangement of intestinal digestion is noticed, due to the 
same cause affecting the mucous membrane and viscera secreting the 
intestinal fluids ; all are affected until they fail to meet the demands of 
normal life, and require abnormal stimulation : here lies danger. 

The respiratory function is so intimately linked with that of circu- 
lation that it is hard to separate what is popularly termed "rum 
consumption " into its factors. The lungs fail because the circulation 
is faulty, the circulation fails because the vaso-motor force is low, and 
the vital energies flag because the blood is improperly, imperfectly 
aerated ; so the curse is moved around the circle. Dr. B W. Rich- 
ardson, writing of this condition, says : " For many years these 
sufferers, owing to a splendid conformation of the body, may live 
apparently uninfluenced by any disease, in which respect they differ 
from alcoholics generally, and in fact are instanced by votaries of 
Bacchus, as men who drink deep and seem never worse for drinking. 
This wonderful health is however, after all, apparent only. Ques- 
tioned closely, it is soon discovered that these victims have long been 
out of health ; that a slight influence such as a cold has easily depressed 
them, that, subjected to unusual excitement or unusual fatigue, their 
balance of strength against exertion is weakened, and that an extra 
quantity of alcohol has often been wanted to bring them up to their 
required activity. Nevertheless they pass for healthy men ; they look 
healthy, and retain their good looks to the last. * * * * There 
is no remedy whatever for alcoholic phthisis ; it may be delayed in its 
course, but it is never stopped, and not nnfrequently, instead of being 
delayed, it runs to a fatal termination more rapidly than is common in 
any other type of disorder." 

Such are the statements of one fitted to give judgment. Turning 
now to consider the effects of alcohol upon those organs which 
eliminate the waste from the system, the liver is of the first impor- 
tance, because upon it more than any single organ depends the 
completion of the eliminative process : the entire volume of blood 
from the abdominal circulation, passing through its structure and 
there freeing itself from a load of effete material. 

Thirty-Fifth Semi- Annual Meeting. < 9 

Dr. Richardson writes thus: "The organ of the body which most- 
frequently, perhaps, undergoes structural changes from alcohol is the 
liver. The capacity of this organ for holding active substances in its 
cellular parts is one of its physiological distinctions. In instances of 
poisoning by arsenic, antimony, strychnine, and other poisonous com- 
pounds, we find in conducting our analysis, the liver to be, as it were, 
the central depot of the foreign matter. It is the same practically in 
poisoning with alcohol. The liver of the confirmed alcoholic is prob- 
ably never free from the influence of the poison, it is often saturated 
with it." Exception cannot be taken to these statements ; the term 
44 hob-nailed " has a well understood significance, being the synonym 
for " gin-drinkers' liver," L e., the organ has lost its cellular parts, 
hence the term 44 contracted " ; the pathological condition explains the 
dropsical symptoms, they arise because the return circulation is checked 
by the contracted state of the hepatic structures. 

A similar state of tissue change occurs in the kidneys. Loss of the 
soft parts by fatty degeneration interferes with the relation of the 
blood vessels and excretory structures, so that the relation between 
salts, albumen, and water, cannot be maintained ; the body wastes, 
being drained of material needed in tissue building, and the patient is 
6aid to have 44 Bright's disease," even by those who are unable to make 
technical distinctions. Nature has hung out her danger signals that 
are recognized by experts in ophthalmoscopy, and by microscopists ; the 
patients disregard them at their peril. 

When we come to the 6tudy of the nervous system for localized 
symptoms of the abuse pf alcohol, we have forced upon us the truth 
that if one member suffer, all the members suffer with it. It ia 
claimed by some, that the most direct, most powerful effect of alcohol, 
is upon the brain and general nervous system, ganglia and ramifica- 
tions, so that the changes in special organs are due to loss of nervous 
energy and inability to resist the effect of alcohol upon their structures. 
The special senses are dulled, as can be shown by careful tests made 
before and after its use ; a similar narcosis is produced upon the entire 
system, so that we have the local effect upon remote organs added to 
the centric effect of diminished nervous energy. Although the effecta 
upon the nervous system are general, yet it is true that local lesions, 
causing paralysis of lower or upper extremities, occur more frequently 
in alcoholized subjects, because its force is added to predisposing 

Not only is alcohol the direct cause of the conditions hist consid- 
ered, but expert testimony, both here and abroad, is unanimous that it 

10 Proceedings. 

is a principal predisposing cause of insanity, the only point of differ- 
ence being the percentage allowed. Gustafson quotes authorities as 
follows : 

Dr. F. Ganghofner, of Prague, say6, " It is estimated that in the 
asj^ums of America, England, and Holland, the total number of 
insane, from drink, ranges from 15 to 20 per cent, and from 20 to 25 
per cent, in the asylums of France." 

The third report on intemperance before the select Committee of 
the House of Commons shows from 1865 to 1875 an increase in popu- 
lation of 14 per cent, and in drunkenness of 130 per cent. 

Mr. Hoyle 6tates that the number of lunatics in asylums and work- 
houses in the United Kingdom, will be slightly over 100,000, besides 
many not in asylums. In England and Wales in the year 1860 there 
were 38,038, but in 1880 they had increased to 79,191, being nearly 
double, although the population had increased only 28 per cent. 

W. J. Corbet, in a striking paper entitled, Is Insanity on the 
Increase ? {Fortnightly lieview, 1884,) says, "After being engaged for 
many years, and under special circumstances, in studying the statistics 
of insanity I have reluctantly come to the conclusion that facts and 
figures establish clearly the progressive growth of the malady. * * 
It would only be wearisome to enter more fully into statistical details, 
any one that wishes, and has leisure, can scrutinize for himself. The 
plain fact stands out, however others may try to disguise it in words, 
that in the brief course of two decades the insane in the kingdom have 
nearly doubled in number, in spite of the most elaborate and costly 
means provided to cure them. There is, moreover, another alarming 
feature, in that we evidently do not yet know the worst. The ominous 
words ' inadequate accommodation ' and 4 increase of provision ' run 
through the whole series of reports from beginning to end." 

Gustafson quotes from the report to the Belgian Chamber of Repre- 
sentatives by the Minister of Instruction (Brussels, 1868), in which 
the following facts are given as the drink results for England : 

(1.) Nine-tenths of the paupers of whom, according to Hoyle, there 
were over three and a half millions in 1881. (2.) Three fourths of 
the criminals. (3.) One-half of the diseases. (4.) One third of the 
insanity. (5.) Three-fourths of the depravity of children and young 
people. (6.) One third of the shipwrecks. He quotes American 
authorities as follows : Dr. Lee, of Philadelphia, in Report on 
Insanity (1868), gave for the year 1860, one insane person to every 
1,305 inhabitants, and in 1868, one to every 700. In his u Insanity 
and Insane Asylums" (Sacramento, 1872), Dr. E. T. Williams, Com- 

Thirty- Fifth Semi-Annual Meeting. 11 

missioner in Lunacy for the State of California, states (p. 211) that it 
is his opinion intoxication is a far mightier cause of mental diseases 
than all other causes put together, and then adds : " The last United 
States census shows that there has been a most alarming increase in the 
number of lunatics and idiots ; during the last decade, while the popu- 
lation has increased by 20 per cent., the increase of the insane is given 
as a little over 155 per cent." 

If the consequences of wrong action ended with the individual, the 
case would be bad enough, but it is a sad fact that the reproduction of 
the species gives a line of heredity, that goes on not only to the third 
and fourth generations, but to an extent not possible to measure, till 
one does not wonder that the proposition to have criminals deprived 
of the power to reproduce their kincf, has been proposed in essays 
written by those having the largest experience in our public institutions. 

Harsh as this may seem, it is only anticipating the course of nature, 
for Professor Kraft, in Psychiatrie (Stuttgart, 1883), quoted by 
Gustafson, shows how nature disposes of generations of drunkards. 
First generation — moral depravity, alcoholic excess; second genera- 
Hon — drink mania, attacks of insanity, general insanity ; third 
generation — hypochondria, melancholic apathy and tendency to murder ; 
fourth generation — imbecility, idiocy, and extinction of the family." 

Mr. Cabot previously quoted, after referring to a statement of Lord 
Shaftesbury, to the effect that intemperance is the cause of fully two- 
thirds of the insanity that prevails, either in the drunkards themselves 
or their children ; also to one made in an address in the House of 
Lords to the effect that fully six -tenths of all the cases of insanity to 
be found in these realms and in America arises from no other cause 
than intemperance, goes on to say, " I go a step further, and hold that 
there is abundance of evidence to prove that to dissipation, drunkenness, 
and moral depravity, either directly or consequentially by transmission 
to the next generation, is to be charged an immense proportion of the 
annual increase of lunacy. No person of authority will be found to 
deny that evil and corrupt living in the parents, bears fruit of an 
unhealthy state of both body and mind in their offspring. In the lower 
animals the transmission not only of generic qualities, but even of indi- 
vidual singularities, is a similar fact ; so with mankind it is not to be 
expected that a pure stream will issue from a polluted source ; and how 
foul and corrupt that source must be any one who sees the habits of 
the swarms of unfortunate creatures who nightly crowd the streets of 
our great cities may determine for himself. * * * * It is said 
that people now-a-days are impatient of restraint and betray a tendency 

12 Proceedings. 

to abandon all attempt at self discipline and to yield to every impulse 
good or bad. If true, it is sad indeed, for it is, and from time imme- 
morial has been, an indication of national decay. The great empires of 
old perished not from sudden and violent convulsions, but from the 
moral degradation of these people from internal rottenness, amounting 
to national insanity. Quern deus vult perdere primus dementat" 

In view of these sad effects of alcohol where shall we draw the line 
between the use and abuse ? The lirst declaration on this subject, as 
given by Gustafson, was drawn up by Dr. Julius Jeffreys, in 1839, and 
signed by Sir Benjamin Brodie, and seventy-eight leading practitioners 
of medicine and surgery. The following sentences show their view of 
this theme : " An opinion handed down from rude and ignorant times, 
and imbibed by Englishmen from their youth, has become very gen- 
eral, that the habitual use of some portion of alcoholic drink — as of 
wine, beer or spirit — is beneficial to health, and even necessary to those 
subjected to habitual labor. Anatomy, Physiology, and the experience 
of all ages and countries, when properly examined, must satisfy every 
mind, well informed in medical science, that the above opinion is alto- 
gether erroneous. Man in ordinary health, like other animals, requires 
not any such stimulants, and cannot be benefited by the habitual 
employment of any quantity, large or small ; nor will their use during 
his life time increase the aggregate amount of his labor. In whatever 
quantity they are employed they tend rather to diminish it. When he 
is in a state of temporary debility from illness, or other causes, a tem- 
porary use of them as of other stimulant medicines may be desirable ; 
but as soon as he is raised to his natural standard of health, a continu- 
ance of their use can do no more good to him even in the most mod 
erate quantities ; while larger quantities (yet such as by many persons 
are thought moderate) do, sooner or later, prove injurious to the human 
constitution without any exception." 

In this connection let me give you the indication for the use of alco- 
hol, cited from the standard authorities : 

Stille says that " alcohol is the usual and familiar remedy for debility, 
shock, or fatigue, and syncope ; in typhus and typhoid fever, in pyae- 
mia, relapsing fever, and diphtheria. That it should never be allowed 
to produce intoxication even by abnormally exciting, still less by stupe- 

Wood gives similar indications, and adds : u In chronic diseases great 
care is necessary in the exhibition of the remedy, for fear of begetting 
intemperate habits. This is especially the case in neuralgia, and other 
painful affections, in which the narcotic influence of alcohol may be 

Thirty-Fifth Semi- Annual Meeting. 13 

very soothing ; under these circumstances there is a constant tendency 
to an increase of the frequency and size of the dose. Taken habit- 
ually in excess, alcohol produces the most deplorable results, and is a 
very common cause of fatal maladies." 

What has been the practice of the profession in the matter of alco- 
holic liquors ? This question lias been forced upon my attention dur- 
ing the past ten years by my relations in one of the institutions of the 
city of New York, established for the reformation of the intemperate,* 
and I am compelled to believe that the administration of alcohol has 
been characterized by a recklessness which would be criminal if it were 
less thoughtless ; there has been a happy -go-luck, off-hand prescription 
of alcohol, as the easy, natural, inevitable 1 stimulant ; the form, the 
amount, the frequency of the dose being left to the patient !!! Not 
only so, but this has been done without the question, or the thought of 
the patient's previous poisoning with alcohol. Many reformed men 
have relapsed under the mistaken or careless advice of the family phy- 
sician. It is wrong, it is cruel, to throw the responsibility on the 
patient ; his moral sense is weak, his will is weaker still, and his medi- 
cal adviser, therefore, cannot shift the responsibility from himself to 
his patient. But a better day is at hand, a greater degree of caution is 
now exercised by our more thoughtful and conservative practitioners. 

Allow me to reinforce my own remarks by those of older and wiser 
men. Gustafson quotes an article written by Dr. McMurtry, of Bel- 
fast, in 1871 ; the following paragraphs are of interest in this connec- 
tion : 

" The ignorance of the people, encouraged as it has been by the atti- 
tude of the medical profession toward the temperance movement, with 
regard to the nature, properties, and real value of alcoholic drinks, has 
constituted hitherto an almost impregnable barrier to the progress of 
truth on this subject. Medical practice, and medical teaching, and per- 
haps medical science altogether, have begotten and fostered the popu- 
lar belief that alcohol is one of the good creatures of God. The med- 
ical profession is responsible for the originating and perpetuating of 
the great mistake that alcohol is a wholesome thing. 

The people's medical advisers either teach by precept and example 
that they are not injurious, or manifest an indifference to the evils pro- 
duced by their use, which implies that they do not think them injurious. 

It matters little whether it is what they teach, or what they do not 
teach, that is the cause of popular belief and popular custom, for med- 
ical men are just as responsible for its consequences, because it is their 

*New York Christian Home for Intemperate Men. 

14 Proceedings. 

special province and privilege to diffuse that light and knowledge which 
alone conld prevent them. For to whom can the temperance move- 
ment look, to whom should it look for aid in exposing this pernicious 
falsehood, but to the medical profession ? To whom else should a com- 
munity suffering from the physical consequences of a physical poison 
appeal, not only for their cure, but for their prevention ? Apart from 
the absolute duty of every man to abstain from the unnecessary use of 
a poison, it is preeminently the duty of medical men, who are natur- 
ally and justly considered guides in all that pertains to the preservation 
of health, to see that the powerful influence of their example is on the 
side of virtue and sobriety. Their superior knowledge of the poison- 
ous nature of alcohol implies a greater obligation to abstain from it ; 
but it is their stronger and wider influence which, in an especial man- 
ner, lays them under a deeper responsibility to set the people a safe 
example in this matter, and incurs upon them a deeper guilt if their 
example leads the people astray. Hence, I maintain that it is the duty 
of medical men either (1) to disown alcohol altogether, on the strength 
of a verdict which a large proportion of the profession — not to men- 
tion competent judges outside the profession — have pronounced it ; or 
else (2) to examine the matter for themselves with an earnest and sin- 
cere desire to know the truth, considering the incalculable evils which 
so many truthful, unprejudiced, and thoroughly qualified men attri- 
bute solely to the common and medicinal use of alcohol (such use being 
founded on false notions of the nature and real value of the drink). I 
hold that it is the bounden duty of all who are in any degree responsi- 
ble for the use of it, to give the whole subject that honest and atten- 
tive consideration which its importance demands. This would be a 
more philosophic, honorable, and philanthropic course to pursue than 
that so often adopted by medical men, of refusing either to study the 
question for themselves, or to be instructed by those who have studied 
it. I should have thought that if no other or higher consideration 
were sufficient, the honor of their profession would be enough to 
arouse then- to defend it from the serious charge of contributing, 
either knowingly or in wilful ignorance, to the miseries of the human 

" But suppose that after having given the subject the necessary inves- 
tigation, they still believe that alcohol is an indispensable article of the 
Materia Medica, what then ? What if some medical men have actually 
done so, and have been forced to the conclusion that alcohol is a useful 
food and a necessary medicine ? Then I tell them that it is their duty 
(?>) to choose the lesser of the two evils. Prescribe alcohol, either diet- 

Thirty-Fifth Semi-Anncal Meeting. 15 

ically or medicinally, and you frequently create or resuscitate, and always 
run a risk of creating or resuscitating, supposing the patient survives, au 
uncontrollable and ultimately false appetite for intoxicating drink. 
Thus, in your desire to cure one disease, which many believe could be 
cured more certainly and safely by other means, you administer a rem- 
edy which may and often does produce another disease of a much more 
serious character, inasmuch as it involves not only physical, but moral 
injury to the patient, and untold misery to his friends. 

" You also give use to and confirm that widespread faith of the neces- 
sity for, and remedial powers of, alcoholic liquors, which I have said is 
at the very basis of the drinking customs, and is the remote origin of the 
traffic itself and all its evils. For while I do not say that all who drink, 
do so because they think the drink in good for them, I do say that they 
all began to drink ignorant of the fact that alcohol is inherently and 
essentially bad for them, and this ignorance is the result of the prescrip- 
tion and recommendation by medical men of the various intoxicating 
productions of the brewer and the distiller. And remember that the ad- 
vocate of alcohol can claim no especial advantages for the alcoholic treat- 
ment, which are not also claimed to a superior degree for the non- 
alcoholic treatment, by those who have expunged the agent from their 
list of remedies altogether." 

This article was influential in leading to a declaration as suggested by 
the British Medical Journal, which was signed by two hundred and 
fifty-nine of the English physicians and surgeons. I quote it : 

" As it is believed that the inconsiderate prescription of large quan- 
tities of alcoholic liquids by medical men, for their patients, has given 
use in many instances to the formation of intemperate habits, the 
undersigned, while unable to abandon the use of alcohol in the treat- 
ment of certain cases of diseases, are yet of opinion that no medical 
practitioner should prescribe it without a sense of grave responsibility. 
They believe that alcohol, in whatever form, should be prescribed with 
as much care as any powerful drug, and that the directions for its use 
should be so framed as not to be interpreted as a sanction for excess, or 
necessarily for the continuance of its use when the occasion is past. 

" They are also of the opinion that many people immensely exagger- 
ate the value of alcohol as an article of diet, and since no class of men 
see so much of its ill effects, and possess such power to restrain its 
abuse, as members of our own profession, they hold that every medi- 
cal practitioner is bound to exert his utmost to inculcate habits of great 
moderation in the use of alcoholic liquids. 

" Being also convinced that the great amount of drinking of alcoholic 
liquors among the working classes of this country is one of the greatest 

16 Proceedings. 

evils of the day, destroying, more than anything else, the health, happi- 
ness, and welfare of these classes, and neutralizing to a large extent the 
great industrial prosperity which Providence has placed • within the 
reach of this nation, the undersigned would gladly support any wise 
legislation which would tend to restrict within proper limits the use of 
alcoholic beverages, and gradually introduce habits of temperance." 

This paper caused great excitement and led to some hot words. 
Gustafson says, and this from the Pall Mall Gazette, has no uncertain 
sound : — 

" Although there are those who express indignation at the assumption 
that alcohol is ever prescribed inconsiderately in large quantities, or 
that sufficient care is not always taken to cut it off at the right moment, 
and to arrest subsequent habits of induced tippling, there are too many 
well-known examples of habitual evil induced by medical prescription 
to make us hesitate to accept the declaration in every word, and in all 
its meanings." 

If such a manifesto was called for fifteen years ago, it is more in 
demand just now, in view of the prominence which the question is 
taking in all public affairs. Let me quote a few paragraphs from the 
code of ethics of the American Institute of Homoeopathy, which has 
been adopted as our expression of ethical relations. 

u Section I. — The physician should hold himself in perfect readiness 
to obey the calls of the sick. He should ever bear in mind the sacred 
character of his calling, and the great responsibility which it involves, 
and should remember that the comfort, the health, and the life of his 
patient, depends upon the skill, attention and faithfulness with which 
he performs his professional duties. 

" Section II. — In no other profession should a higher standard of 
morality, and greater purity of personal character, be required. Physi- 
cians ought to come up to this standard, and do all they can to exalt it. 
As the practice of medicine requires the constant exercise of a vigorous 
and clear understanding, and as the practitioner should be, at all times, 
ready for any emergencies in which the life of a fellow creature may 
depend upon his steady hand, acute eye, and unclouded brain, it is in- 
cumbent upon the physician to be temperate in all things. 

" Section IV. — * * * For the physician should always bear 
in mind that the great object of his profession is to cure the sick, and 
that it is not only admissible, but it is his solemn duty to investigate, 
thoroughly and without prejudice, whatever offers any probability of 
adding to his knowledge of the art and means of curing, and of thus 
enriching the science of medicine. 


Thirty-Fifth Semi- Annual Meeting. 17 

" Section V. — As good citizens it is the duty of physicians to be 
vigilant for the welfare of the community, and to bear their part in 
sustaining its institutions and burdens. They should always be ready 
to give counsel to the public in relation to matters appertaining to their 
profession, as for example on subjects of medical police, public hygiene, 
and legal medicine." 

This Society has adopted the foregoing language as our expression 
of ethical views. They were from the pen of the late Carrol Dunham, 
M. D., they harmonize with and enforce our theme, as if written for 
the purpose. If we emulate the spirit of our honored teacher and 
exemplar, we shall weigh well the considerations presented to you to- 
day, they are the spirit of benevolence, the spirit of good will to our 
fellow men. 

We have less need to use alcohol than those of opposite views of the 
practice of medicine, for we know that every properly selected remedy 
is a stimulant, in the broadest sense ; but I fear there is a tendency to 
forget the master, to resort to expedients, such as alcohol, to be satisfied 
with diagnosis, to prescribe for diseases instead of conditions, as indi- 
cated by symptoms. For these reasons we shall fail of the laurels won 
by those who forced upon the profession a milder practice than that 
which was once dominant. 

In view of this code of ethics which we adopt, let me appeal to you 
to give it a personal, as well as an organic endorsement, by example, 
by teaching, by private and public protest against the drinking customs 
of the times, do all that is in your power to arrest the tide of intem- 
perance that threatens our beloved America and the w r orld. I live in 
the hope, yes, the confident anticipation of the time when the public 
mind shall be so educated to the fact that alcohol is a narcotic poison, 
that the alcohol drinker shall be under the same ban as the opium 
eater ; that alcohol shall no longer be sold in saloons, over the bar, but 
its sale shall be restricted to the hands of responsible druggists, who 
shall, by the same educated public sentiment, be held subject to public 
censure for any and every known malfeasance of its issue, as they are 
now adjudged regarding the sale of opium, or any other narcotic poison 
for similar purpose. 

A vote of thanks to the speaker w r as unanimously adopted. 

Moved by Dr. Lee, seconded by Dr. Wolcott, that a committee of 
three be appointed to report at morning session on advisability of 
printing the President's address. 



1* PfcM_tfcl»IX«— . 

Dk*. Lee. Ha^bkock and W«ji> ■ tt w^re ap{»:rited »ueh a com- 

On motion, Dk. JIa>broick read a paper entitled - Homoeopathic 
Periodicals arid Medical Advertising/* 


A. It. Wkioht. M. D., Chairman, presented the following paper: 
" A Plea for Total Extirpation of the Cancerous Interns Under Con- 
ditions" of which he wa* the anthor. 


Tjios. D. Spexcek, M. D., Chairman, being absent through sickness, 
the papers of lib bureau were presented by Dr. J. M. Lee. The first 
paper, "The Treatment of the Pedicle in Hysterotomy." by Dr. 
II. I. Ostroin, was read bv title. 

On motion, further consideration of this bureau was deferred until 
the morning session. 

The Society then adjourned until 9 a. m. Wednesday. 


Society called to order by First Vice-President F. Park Lewis, M. D. 

lie port of Bureau of Surgery continued. The following papers were 
presented : " Observations on the Medical and Surgical Treatment of 
Tumors and Cancers of the Breast/' Dr. M. O. Terry, "Mam- 
mary Tumor. Was it Schirrus f" Dr. R. C. Moffat, "Mammary 
Tumors " — Clinical Cases, Dr. George Allen. 


The Committee on President's Address recommended that it be 
published in monograph form, the expense thereof to be defrayed by 
voluntary subscription. Also, that the address be published in the 
following journals : 

The Clinique, North American Journal of Homoeopathy, 
Physician*' and Surgeons' Investigator and The Clinical Review. 
Keport accepted and committee discharged. 

Thirty-Fifth Semi-Annual Meeting. 19 

On motion, a cominmittee consisting of Drs. Wolcott, Lee and 
Wripht were appointed to solicit contributions. The committee 
subsequently reported that the amount of $22.00 had been collected. 


Chas. F. Sterling, M. D., Chairman, being absent, Dr. F. Park 
Lewis presented a paper on the u Treatment of Senile Cataract." 


Wm. P. Fowler, M. D., Chairman. In the absence of the Chair- 
man, Dr. Moffat presented a paper on " Treatment of Eczema of the 
Ear," by Dr. Fowler. 

Samuel Lilienthal, M. D., Chairman. {No papers.) 


Gertrude Goewey-Bishop, M, D., Chairman. In the absence of 
the Chairman, the following papers were presented by Dr. Moffat : 
" Marasmus Infantum " — Dr. Susan S. McKinney ; " A Question, 
or Eczema Capitas," by Dr. S. Catherine Martineau ; " Summer 
Complaint," by Dr. J. E. Slaught. 


George M. Dillow, M. D., Chairman. {No papers.) 


H. M. Paine, M. D., Chairman. " Purification of Water," by 
Dr. George Allen. 

Dr. Paine, of Committee on Legislation, reported the following 
resolution, which was adopted : 

Resolved, That the Homoeopathic Medical Society of the State of 
New York endorses the proposition made by the Medical Society of 
the State of New York, as set forth by its committee on legislation, 
and presented to the recent session of the State Legislature, under 
Senate bill 485, the purpose of said bill being the simplification and 
codification of the laws of this State relating to the practice of medicine 
and surgery. 

Resolved, That the county and local medical societies of this State 
and members of the profession generally are requested to promote, to 




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i'w,tr* i,'**r.'.*. ',:,-/.'.'.' \:~ .Svr-'^rr ••> *zzr^.i t^r iztetcr^ of their 
Ht^f^ J«/^^.y to xth \*j\ ;r Fr.r^-r'zlii Se:c r »:l-^>i- w»& received, 

T>^' 7*wr<#*ry rt-yrttA *:& fo\lowiz.z az-:'i:-arl;i.* for membership : 

Jliv, Fmki/ S. Vi:t;ros. (jvjk W. Lew;-. Jk.. Geoege Clejstox 

AwtUM, Ww, E. J/ >:•',, Joh.v deVelx#> Moj'Ee. -T. D. Hedtemaxx, 

'\\n' wtmuttitw: i>\\ ^Clinical Te»t-? of Potencies" being about to 
i^.iK' it dr^filar, the following re^ilution was adopted : 

/AW/w/ f Tliattlirj ''//mmittee be instructed to refrain from inserting 
jh Um' /'ir^uhir aboui to 1x5 ii>*ued 9 all expressions of opinions in refer- 
ftu'H Ut l\tt: wcditttbility of eureri by *' high potencies/* 

\Ui, \\s*\\iu>vi,K rwlhtfl attention to the impoverished finances of the 
MoHHy iiim! utye*\ ;dl ftietribera to promptly remit their dues. 

Mov*'<l by | In, Wom:ott, wjconded l>y Dr. Moffat, that the thanks 
of llin HoriHy be teii(|iTc<| Ilu. Paine for his labors in behalf of 
mi'illiMil h-j/i^ljilJon at Albany. 

Thirty-Fifth Semi-Annual Meeting. 21 

Dr. Paine suitably responded. 

On motion of Dr. Moffat, seconded by Dr. Lenggenhager, a vote 
of thanks was tendered the proprietors of the Cataract House for 
their courteous attention and reduction of rates. 

Dr. Nottingham cordially invited the Society to attend the meeting 
of the Michigan State Homoeopathic Medical Society. 

The Soeietv then adjourned. 




Thirty-Sixth Annual Meeting of the Homoeopathic Medical Society of the State 

of New York, held in the Common Council Chamber, City Hall, 

Albany, NY., Tuesday and Wednesday, February 

8th and 9th, 1887. 

The Society was called to order at 10 o'clock, a. m., by the President, 
Henry C. Houghton, M. D., New York City. 

Prayer was offered by Dr. J. J. Mitchell, of Newburgh. 

The First Vice-President being in the chair, the President 
delivered the following address : 

Ladies and Gentlemen : 

It seems but yesterday since your action placed me in this honorable 
position and under renewed fraternal obligations. A few hours, the 
year's work will have been completed and we shall launch upon the 
unwritten history of another fiscal year. This is not the time for 
moralizing, but one cannot fail to be impressed by the thought that 
present opportunities must be seized upon without debate and earnestly 
appropriated, lest tardy action cause unavailing regrets. 

A review of the work of the Society for the year presents nothing 
of unusual note. The interests of the Society are in the keeping of 1 
the Executive Committee, ad interim, and any care they may have 
had has been due to the activity and zeal of certain members, rather 
than a solicitude that life should end from coma. The Legislative 
Committee had an interesting " combine " early in the year, concerning 
which we shall hear in detail from our irrepressible Chairman. The 
session at Niagara Falls was a somewhat uproarious one, when we con- 
sider the number present, and the fact that some of them were com- 
pletely mystified and others subject to a proving of a potency of Dema ; 
it is to be regretted that the members do not avail themselves of the 
opportunities offered at the semi-annual sessions, for scientific discus- 
sion and fraternal intercourse, free at that time from all the disturbing, 
however necessary thev mav be, elements of legislative and official 


Thirty-Sixth Annual Meeting. 23 

The intercourse of the year has been characterized by a fraternal 
spirit, there being so iar as I know, no element of discord in our 
midst. Our members are doing good service to mankind in the 
activities of private practice and public charities ; giving an amount 
of unrequited benefactions in the shape of skilled attentions and 
expert advice, that is too often not only unrequited but apparently 
unappreciated ; at other times, thank God, so heartily appreciated that 
the compensation is beyond that of gold, because it shows that the 
divine is not lost even among those counted of least esteem among men. 

As a Society we have also the hearty support of the laity, as shown 
by a private support as practitioners in the various communities of the 
State, where we have the confidence of the best citizens, as they trust 
to our care those whom they hold dearest in all the ties of life ; confi- 
dence shown in the maintenance and multiplication of institutions for 
the care of the sick, the support of the poor and the aged, as well as hearty 
endorsement of our plans for the education of those who in coming 
years must be ready to take upon themselves similar duty, as their 
seniors drop from the ranks. We claim also the respect due to success, 
from those who may not altogether agree with us as to our methods of 
medication, and it is not an uncommon thing to have the counsel of 
our experienced members solicited by those of opposite faith and 
practice, in the medical care of their families. We claim, because we 
merit, the respect of our friends of the opposite side, the dominant 
school of medicine. We merit it because of success, because of sur- 
vival ; having demonstrated, by a half century of testing, under the 
most adverse circumstances, that we have a mission, even the redemp- 
tion of the practice of the healing art from the crude, empirical, 
unscientific, harsh, hazardous methods of the past, to the refined, fixed, 
according to principle, gentle, safe methods of to-day. In this we 
stand united, having parted with those who left us because they were 
not of us. Possibly there a few malcontents in the camp ; absolute 
unity is hardly to be expected in medical organizations. We are justly 
labeled as more tenacious of our opinions than the clergy or the legal 
practitioners, the natural result of ages of conservative practice. 

If the respect which we claim from our friends, the enemy, had been 
rendered to us fiftv years ago, there would have been no occasion for 
u New Code ' ' enactments, no sects in medicine, no plea for " liberal 
medicine.'" I have had occasion recently to refer to the history of our 
Society in other relations and I find the lessons there learned not inop- 
portune in this presence. 


From lMf'j to l*. r iti all efforts to obtain any fraternal organization as 
a representative body failed, because of the opposition of the •• regular 
school" — so called. A glimpse of the nature of this opposition may 
l>e had from the following sentence quoted from a letter to Hon. Win. 
Kelly hy Dr. Vanderberg, written u[K>n the occasion of the passage uf 
the Senate Hill, March 1, ls.">'i, authorizing the formation of honneop- 
atiiic societies : •• What shall we render to yon for such service ? 
You have abolished the sentence of outlawry, confirmed by the approval 
of three generations against us! You have legalized a profession that 
lias borne tlie finger of scorn for fifty years and have given ns the con- 
solation of knowing that when the pilgrimage of this life is ended, we 
may be buried in consecrated ground." 

The younger members of this Society can have little idea of the ban 
put upon those who adopted homoeopathic practice. It must be a sad 
case that called for such words as the following from the lips of the 
late Carrol Dunham, M. D. : " The most bitter aspersions upon Hahne- 
mann's personal character, abounding in the most concentrated con- 
tempt and scorn of the system which Hahnemann had unfolded — and 
from that day to the present, all the utterances of the old school, 
whether from the press, the council, the professor's chair, or in the 
forum of the academy, have been bitter, personal denunciations of the 
character and motives of Hahnemann, and of all who have adopted or 
have even shown a disposition to investigate his methods." 

Tn what manner and to what degree has the nature of the dominant 
school changed i Will the lion and the lamb lie down together, with- 
out demonstrating the falsity of the axiom, that two bodies cannot 
occupy the same space at the same time { Personalty, there has come 
a great change. Organically, officially, very little ; the societies adhere 
to tlie same line of action that expelled our seniors. The younger men 
are fraternal, progressive, glad to avail themselves of anything new, if it 
be useful, helpful; but the genius of the medical profession is not 
favorable to progressive ideas, and the young men must wait, not only 
for fees, but also for freedom. The " New Code" episode in the his- 
lopathic branch of the medical profession is the result 
Din without rather than within the body. The spirit 
one of liberality ; the laity have long had a supreme 
ic bigoted policy that has hindered them from having 
memlrere of our school, simply because the old school 
; us. The fact is one that needs no argument ; the laity 
■ practice, even in families nominally under old school 
remedies in ordinary sickness, till they have been in 

Thirty-Sixth Annual Meeting. 25 

advance of the medical adviser, often abandoning the old for the new, 
because of the conservatism which would not even listen to the pos- 
sibility that good could come out of Nazareth." I have said that we 
are to-day indebted to the intelligent, progressive laymen for the liberal 
spirit that has controlled legislation, specially in this, the Empire State. 

After fift3 T years of opposition in every way possible onr friends of 
the dominant school have come to realize the fact that they cannot con- 
trol legislation and carry a measure to success without recognizing our 
claim to a respectful hearing, because we have and hold a large share 
of the patronage of the wealthy and educated classes of community 
and the public sentiment to support our practice. This is not a change 
of nature, but a change in methods ; not altered purpose, but changed 
plans, as one of our quasi friends said last year : " We have fought 
homoeopathy for fifty years and it has prospered under persecution ; 
now we propose to hug it to death." Well, this is in keeping with 
history. By the aid of Ringer and Barthelow they have squeezed out 
the principle in the shape of " Physiological Medicine" which is the 
essence of Hahnemann's teaching; then they appropriated our phar- 
maceutical processes by the " Fuller method" an instance of irregular, 
regular, minimum dosage. Now they propose to expel the vital spark 
by affectionate embraces. 

Fable. — A certain professor of natural history gave his son a lesson 
in bee culture, showing from plates the methods by which the bee 
carried honey to the hive. One day when the little fellow was eating 
sweets in the garden a bee lighted on his dish ; he thought he would 
make some original investigation, so he caught the bee, but before the 
search had advanced to the end desired, another end became active, and 
the loving father was hastily sought for advice and comfort. Moral. — 
Sinister methods are not safe. Ingenuousness is better than craftiness. 

Allow me to dwell for a moment upon a term which I have already 
quoted, " liberal medicine." It was my belief in " liberal medicine " 
that made me a member of this Society ; it is that which will keep me 
such till liberality is manifested by those at whose door lies the 
responsibility for schools, and sects and divisions in the profession. 
One of our oldest, ablest, most experienced, most successful physiciana 
is senior editor of an able journal devoted to the interests of 
liberal medicine, in the earnest effort to unite the profession. If I 
mistake not, our honored colleague was never called to such a case of 
dystocia ; the analogy will not bear severe strain, but if I suggest that 
if the presentation be vertex or breech, the passage of liberty of thought 
and action offered to us by the dominant school of medicine to-day is. 

2*5 !*!:■■ *.k: »:>•--. 

too narrow for tb> :-*dv. Well •::•] Dut.l.*::. -siv in h> address before 

m m 

this Soviet v in l^-*!. •• N«»w. a- :«. the d-v- .jf IL'.r.eiuaiin. there is an 
antagonism l«etween the }.••:;. i-» •■•!•:.>:* .*:.d ::.e old school. The 
former hold out to the letter tl.-v l«l : eve to lie that method 
which ha> ever lieen a «!•— ; i»-ra*;*:. :•- :i.e»::cii.e. The latter refuse 
even to examine it. ai.d ex;»-l ti •• :.■»::.• *-••;• •■•!.>!* fr«m all associations 
over which ih»*v hoM contra. We caim*** nn:*e with theiu in anv 
associated la'oors. without ijr;«»ri' z j'.'I disavow:::.; we 1 relieve to 
lie the true theory and j»ra'-:l-^e of tl:e all i:i.>irt.i!:t jicirt of medical 
fcience — the science of ti.err,»ent:«->. T^» " »rJ'l /•••* mw/7#- with us in 
associate*! labors for the d»-v»-!-»p:iie::t of t:.> ^-iei.i-e. 

I have a fellow fueling with th«»-e win* de-:rv ;hi- union. There are 
few men who prefer to i»e ostracized, the fact of liking and courting 
adverse criticism i- evidence of a **mred. uuhnmau. not to sav inhuman 
di>jM>sition. Suffering for principle i< not choice — it is necessity. 
Kelief from this po>itioii is not obtainable by art ion on our part, for 
the only step possible on our part is retraction. The retraction must 
come from the side that enacted the expu'-ion. Shall we win any 
additional respect by making overture- to the dominant party ' Wooing 
usually comes from the stronger. So when the venerable, the honor- 
able, the wealthy, the manly old M-hool heart is smitten with a sense of 
desirable union, we mav turn the right side and listen to the remarkable 
change in its language. Meanwhile, we will maintain our position. 

There is another reason for maintaining our |>o>itioii. We are under 
obligation to transmit to others what we have received from our 
seniors, a legacy of untold value, a power that has transformed medical 
practice- I am not sure that the inertia of old medicine has been over- 
come to such an extent that we can safely trust to momentum to carry 
on the work. The time has not come when it is safe for a man to 
announce in old school meetings results which he has obtained from 
the exhibition of remedies known to be used bv us : he mav use them 
in secret, but woe to him if he have the courage of his convictions and 
announce the source of his knowledge. He is met by the cry, " These 
are the method.-* of homoeopathy, let him who advocates them go where 
they are practiced." When the law taught by Hahnemann, by which 
our fathers triumphed, by which we hold our vantage ground, when 
this law is admitted to be a law by which anyone may practice, with- 
out ostracism ; when it is taught in our medical colleges, the choice of 
practice being optional with the student ; when the public hospitals are 
open to a fair test of practice ; when remedies prepared according to 
our methods can be prescribed with hope of honest dealing; when 

Thirty-Sixth Annual Meeting. 27 

service in the army and navy is open to us ; when alumni of old school 
colleges are retained upon their lists and they accept us as rightful pre- 
ceptors ; in short, when all the doors closed against us are cordially 
opened to us, then we may feel sure that the truth for the defence of 
which our veteran members founded this Society, may be safely left to 
do its beneficent work. 

To the duties incumbent upon us let us address ourselves for another 
year. To harvest the fruitage of the past, to sow for the future, 
c ertain things must be kept steadily in view, seduously guarded. 

First. This Society is strictly a fraternal one. It has a legal basis 
it is true, but its success depends simply and solely on the community 
idea, any personal party division element allowed to get foothold will 
be a leaven of discord and destruction. For twenty years I have 
attended these sessions with benefit to myself and to those over whom 
I have had an influence ; the most attractive feature of the society life 
has been the fraternity, the cordial fellow-feeling. I have not always 
agreed with my colleagues, but I believe I have always respected their 
right of judgment and the necessities of difference of belief and action 
growing out of education, antecedents, any and all factors of human 
life. I trust I shall never do otherwise. I am compelled to say that 
during the past half year we have been threatened by a cloud, " no 
bigger than a man's hand " it is true, but one that has in it the possi- 
bilities of unhappy friction. I counsel calm, brief statement of 
difiiculties, short discussion and a cheerful acceptance of the will of the 
majority, joined with a respectful attention to the desires and hopes of 
the minority. 

Second. Finances. " Money makes the mare go." ' However much 
stress may be placed on valuable papers, interesting discussions and 
similar items, the success of this Society depends upon the management 
of its finances and upon the treasurer. We have the plain fact before 
us, of debt — a second fact, no prospect under present condition of 
cancelling the debt, but of its increase. I have given some thought to 
this matter and see but one course to pursue. The receipts are from 
the dues of permanent members and the delegates from the County 
societies — small amounts from sale of Transactions. These are insuffi- 
cient to meet current expenses. The disbursements are for expenses of 
the treasurer's office, salary of secretary, expenses of secretary's office, 
and the issue of the Transactions. The expenses of the secretary and 
of the treasurer, are much the same from year to year. The salary of 
the secretary the same. Hence, the only way to free ourselves from 
debt is to increase the receipts from permanent members and the sale 


too narrow for this IkmIv. Well did Dunham sav in his address before 

• * 

this Society in 18f>3, " Now, as in the davs of Hahnemann, there is an 
antagonism between the honxeopathists and the old school. The 
former hold out to the letter what thev believe to be that method 
which has ever been a desideratum in medicine. The latter refuse 
even to examine it, and expel the homceopathists from all associations 
over which thev hold control. We cannot unite with them in any 
associated labors, without ignoring and disavowing what we believe to 
be the true theory and practice of the all- important part of medical 
science — the science of therapeutics. They will ?tot unite with us in 
associated labors for the development of this science. 

I have a fellow feeling with those who desire this union. There are 
few men who prefer to be ostracized, the fact of liking and courting 
adverse criticism is evidence of a soured, unlnmian, not to 6ay inhuman 
disposition. Suffering for principle is not choice — it is necessity. 
Relief from this position is not obtainable by action on our part, for 
the only step possible on our part is retraction. The retraction must 
come from the side that enacted the expulsion. Shall we win any 
additional respect by making overtures to the dominant party ( Wooing 
usually comes from the stronger. So when the venerable, the honor- 
able, the wealthy, the manly old school heart is smitten with a sense of 
desirable union, we may turn the right side and listen to the remarkable 
change in its language. Meanwhile, we will maintain our position. 

There is another reason for maintaining our position. We are under 
obligation to transmit to others what we have received from our 
seniors, a legacy of untold value, a power that has transformed medical 
practice- I am not sure that the inertia of old medicine has been over- 
come to such an extent that we can safely trust to momentum to carry 
on the work. The time has not come when it is safe for a man to 
announce in old school meetings results which he has obtained from 
the exhibition of remedies known to be used by us ; he may use them 
in secret, but woe to him if he have the courage of his convictions and 
announce the source of his knowledge. He is met by the cry, "These 
are the methods of homoeopathy, let him who advocates them go where 
they are practiced." When the law taught by Hahnemann, by which 
our fathers trium plied, by which we hold our vantage ground, when 
this law is admitted to be a law by which anyone may practice, with- 
out ostracism ; when it is taught in our medical colleges, the choice of 
practice being optional with the student ; when the public hospitals are 
open to a fair test of practice ; when remedies prepared according to 
our methods can be prescribed with hope of honest dealing; when 

Thirty-Sixth Annual Meeting. 27 

service in the army and navy is open to us ; when alumni of old school 
colleges are retained upon their lists and they accept us as rightful pre- 
ceptors ; in short, when all the doors closed against us are cordially 
opened to us, then we may feel sure that the truth for the defence of 
which our veteran members founded this Society, may be safely left to 
do its beneficent work. 

To the duties incumbent upon us let us address ourselves for another 
year. To harvest the fruitage of the past, to sow for the future, 
c ertain things must be kept steadily in view, seduously guarded. 

First. This Society is strictly a fraternal one. It has a legal basis 
it is true, but its success depends simply and solely on the community 
idea, any personal party division element allowed to get foothold will 
be a leaven of discord and destruction. For twenty years I have 
attended these sessions with benefit to myself and to those over whom 
I have had an influence ; the most attractive feature of the society life 
has been the fraternity, the cordial fellow-feeling. I have not always 
agreed with my colleagues, but I believe I have always respected their 
right of judgment and the necessities of difference of belief and action 
growing out of education, antecedents, any and all factors of human 
life. I trust I shall never do otherwise. I am compelled to say that 
during the past half year we have been threatened by a cloud, u no 
bigger than a man's hand " it is true, but one that has in it the possi- 
bilities of unhappy friction. I counsel calm, brief statement of 
difficulties, short discussion and a cheerful acceptance of the will of the 
majority, joined with a respectful attention to the desires and hopes of 
the minority. 

Second. Finances. "Money makes the mare go/' However much 
stress may be placed on valuable papers, interesting discussions and 
similar items, the success of this Society depends upon the management 
of its finances and upon the treasurer. We have the plain fact before 
us, of debt — a second fact, no prospect under present condition of 
cancelling the debt, but of its increase. I have given some thought to 
this matter and see but one course to pursue. The receipts are from 
the dues of permanent members and the delegates from the County 
societies — small amounts from sale of Transactions. These are insuffi- 
cient to meet current expenses. The disbursements are for expenses of 
the treasurer's office, salary of secretary, expenses of secretary's office, 
and the issue of the Transactions. The expenses of the secretary and 
of the treasurer, are much the same from year to year. The salary of 
the secretary the same. Hence, the only way to free ourselves from 
debt is to increase the receipts from permanent members and the sale 

2fi pKocKunijifis. 

too narrow fur this body. Well did Dunham say in liis address before 
this Societv in 1S63, " Now, as in tlie days of Hahnemann, there is an 
antagonism between the houneopathists and the old school. The 
former hold ont to the letter what they believe to lie that method 
which lias ever been a desideratum in medicine. The latter refuse 
even to examine it, and expel the hoina'opathists front all associations 
over which they hold control. We cannot unite with them in any 
associated labors, without ignoring and disavowing what we believe to 
he the true theory and practice of the all-important part of medical 
science — the science of therapeutics. They will nut unit? with us in 
associated labors for the development of this science. 

I have a fellow feeling with those who desire this union. There are 
few men who prefer to be ostracized, the fact of liking and courting 
adverse criticism is evidence of a soured, unhnman, not to say inhuman 
disposition. Suffering for principle is not choice— it is necessity. 
Relief from this position is not obtainable uy action on our part, for 
the only step possible on our part is retraction. The retraction must 
come from the side that enacted the expulsion. Shall we win any 
additional respect by making overtures to the dominant party '. Wooing 
usually comes from the stronger. So when the venerable, the honor- 
able, the wealthy, the manly old school heart is smitten witli a sense of 
desirable union, we may turn the right side and listen to the remarkable 
change in its language. Meanwhile, we will maintain our position. 

There is another reason for maintaining our position. We are under 
obligation to transmit to others what we have received from our 
seniors, a legacy of untold value, a power that has transformed medical 
practice. I am not sure that the inertia of old medicine has been over- 
come to such an extent that we can safely trust to momentum to carry 
on the work. The time has not come when it is safe for a man to 
announce in old school meetings results which lie has obtained from 
the exhibition of remedies known to be used by us ; he may use them 
in secret, but woe to him if he have the courage of his convictions and 
announce the source of his knowledge. He is met by the cry, "These 
are the methods of homoeopathy, let him who advocates them go where 
they are practiced." When the law taught by Hahnemann, by which 
our fathers triumphed, by which we hold our vantage ground, when 
this law is admitted to he a law by which anyone may practice, with- 
out ostracism ; when it is taught in our medical colleges, the choice of 
practice being optional with the student ; when the public hoapitalsare 
open to a fair test of practice ; when remedies prepared according to 
our methods can be prescribed with hope of honest dealing; when 


Thirty-Sixth Annlal Meeting. 27 

service in the army and navy is open to us ; when alumni of old school 
colleges are retained upon their lists and they accept us as rightful pre- 
ceptors ; in short, when all the doors closed against us are cordially 
opened to us, then we may feel sure that the truth for the defence of 
which our veteran members founded this Society, may be safely left to 
do its beneficent work. 

To the duties incumbent upon us let us address ourselves for another 
year. To harvest the fruitage of the past, to sow for the future, 
c ertain things must be kept steadily in view, seduously guarded. 

First. This Society is strictly a fraternal one. It has a legal basis 
it is true, but its success depends simply and solely on the community 
idea, any personal party division element allowed to get foothold will 
be a leaven of discord and destruction. For twenty years I have 
attended these sessions with benefit to myself and to those over whom 
I have had an influence ; the most attractive feature of the society life 
has been the fraternity, the cordial fellow-feeling. I have not always 
agreed with my colleagues, but I believe I have always respected their 
right of judgment and the necessities of difference of belief and action 
growing out of education, antecedents, any and all factors of human 
life. I trust I shall never do otherwise. I am compelled to say that 
during the past half year we have been threatened by a cloud, " no 
bigger than a man's hand" it is true, but one that has in it the possi- 
bilities of unhappy friction. I counsel calm, brief statement of 
difficulties, short discussion and a cheerful acceptance of the will of the 
majority, joined with a respectful attention to the desires and hopes of 
the minority. 

Second. Finances. "Money makes the mare go." However much 
stress may be placed on valuable papers, interesting discussions and 
similar items, the success of this Society depends upon the management 
of its finances and upon the treasurer. We have the plain fact before 
us, of debt — a second fact, no prospect under present condition of 
cancelling the debt, but of its increase. I have given some thought to 
this matter and see but one course to pursue. The receipts are from 
the dues of permanent members and the delegates from the County 
societies — small amounts from sale of Transactions. These are insuffi- 
cient to meet current expenses. The disbursements are for expenses of 
the treasurer's office, salary of secretary, expenses of secretary's office, 
and the issue of the Transactions. The expenses of the secretary and 
of the treasurer, are much the same from year to year. The salary of 
the secretary the same. Hence, the only way to free ourselves from 
debt is to increase the receipts from permanent members and the sale 

28 Prockkdinhs. 

of the Transact !ous,i)Y for a time, at least, deprive the secretary of his 
hard earned salary. An effort should he made to induce every member 
' of our school who has been in practice ten years in the State, to become 
a permanent member ; it would be a graceful return for the position 
lie holds bv virtue of the labor of those who have maintained this 
Society. It may be well to address an appeal to all such. The 
receipts from delegates is fixed, hence no hope in that quarter. 

The Transactions. I understand that the demand under present 
conditions is limited, and we have not far to look for the reason. 
Those who write papers for the Annual or Semi-Annual Meetings, 
naturally desire that they should be published while fresh in mind ; 
if allowed to publish them elsewhere, the Transactions are practically 
valueless ; if we deny this, we dampen the interest of our sessions and 
lessen the practical worth of our records. I propose that we 
meet this dilemma by issuing our Transactions semi-annually in 
two parts, one after each session, promptly, and hold all papers for 
publication therein. Thus we shall make a demand for the Trans- 
actions and meet the wishes of those who contribute. I am very 
confident that this can be made practical. It is hard to find a good 
Seeretarv for love or monev — some good woman usnallv finds him for 
love, but the Societies seldom have monev for Secretaries. I find 
that other State Societies do not pay a salary, but I should favor doing 
so if once free from debt and able from sources mentioned to meet 
that as an item of current expenses, for the burden of the routine 
work falls upon him. Once free from debt, with increased revenue3 
from the sources mentioned, I see no reason whv we could not 
return to our present status. 

Trusting that vou will do as medical men usuallv do in such mat- 
ters, take this advice and these suggestions, and then do as your own 
good judgment may dictate, we will take up the regular order of 

The President having resumed the chair, the Seeretarv read an 
abstract of the minutes of the Semi-Annual Meeting, which was 

The following Committees were then announced : 

On Ptttiiknf* A<l<lrt*# — Drs. Mitchell, Uasbroiick and Gorham. 
Ct\tf* nfiafe — Drs. Terrv and Latimer. 
Auditing — Drs. Bull and Waldo. 
Inrihition* — Drs, Watson and Brown. 

Thirty-Sixth Annual Meeting. 29 

On Regent*? Degree — Drs. Moffat and Bryan. 

Chairmen of Bureaux and Censors — Drs. Lewis, Watson and 



Permanent and Honorary Members — Drs. Holden, Bryan and 


On recommendation of the Board of Censors the following were 
duly elected Permanent Members : 

Names of Applicants, 

Drs. G. T. Borden, Caledonia, Livingston County ; Fred S. Fulton, 
New York City ; J. D. Heineman, Buffalo, Erie County ; George 
Clinton Jeffery, Brooklyn. Kings County ; George W. Lewis, Jr., 
Buffalo, Erie County ; Wm. E. Long, Buffalo, Erie County ; J. de Velio 
Moore, Utica, Oneida County ; Scott W. Skinner, Le Roy, Genesee 
County ; Joseph II. Chamberlain, Belfast, Allegheny County ; Mark S. 
Purdy, Corning, Steuben County ; Ferdinand Seeger, New York City ; 
Charles E. Walker, West Henrietta, Monroe County ; M. W. Van 
Denburg, Fort Edward, Washington County ; II. D. Schenck, Brook- 
lyn, Kings County ; D. B. Hunt, New York City; De Witt G. Wilcox, 
Buffalo, Erie County ; P. A. Banker, Rhinebeck, Dutchess County, 
N.Y. . 

The following members, delegates and visitors were in attendance 
during the sessions : 

Drs. Nelson Hunting, J. W. Cox, E. Darwin Jones, Jas*. F. 
McKown, H. M. Paine, L. M. Pratt, Wm. W. Seeley, C. D. Welch, 
W. F. Robinson, R. B. Sullivan, II. L. Waldo, G. H. Billings, 
Albany Co.; T. L. Brown, Broome Co.; C. P. Cook, S. E. Calkins, 
Columbia Co.; David E. Collins, Greene Co.; L. A. Bull, F. Park 
Lewis, Erie Co.; D. A. Gorton, W. C. Latimer, E. Hasbrouck, J. L. 
Moffat, Kings Co. ; C. E. Walker, Herbert M. Dayfoot, J. M. Lee, 
Monroe Co.; Louis Faust, Montgomery Co.; T. M. Strong, D. B. 
Hunt, Sidney F. Wilcox, Geo. M. Dillow, Fred. S. Fulton, Henry C. 
Houghton, New York Co.; Wm. H. Watson, M. O. Terry, Oneida Co.; 
John J. Mitchell, Selden H. Talcott, Orange Co.; Frank L. Vincent, 
E. S. Coburn, Hiram E. Fuller, Rensselaer Co.; D. E. Spoor, Schen- 
ectady Co.; A. J. Frantz, Seneca Co.; E. W. Bryan, Mark S. 
Purdy, Steuben Co.; A. W. Holden, Washington Co.; H. P. Part- 
ridge, Bennington, Vt. 


30 Proceedings. 


The Treasurer, Dr. E. S. Ooburn, presented the following report : 

Troy, N.. Y., Feb. 8th, 1887. 

Edward S. Coburti, M. D., Treasurer, to The Homoeopathic Medical 
Society of the State of New York, Dr. 

To cash from permanent members, $644 20 

" u county societies, 198 00 

" " sale of books, 106 50 

collected for general index, '. 48 00 

special collection at Niagara Falls, 22 00 

donation by Dr. J. F. Cooper, 5 00 

$1,023 70 


By cash paid as per vouchers, $1,023 70 


Twenty-two certificates of membership not paid for, $ 44 00 

Four members, five years in arrears, 60 00 

Sixteen members, four years in arrears, 192 00 

Seventeen members, three years in arrears, 153 00 

Twenty-one members, two years in arrears, 126 00 

Nineteen members, one year in arrears, 57 00 

$632 00 


Balance of Secretary's salary, , . . . . $319 31 

Referred to the Auditing- Committee, who subsequently reported 
the following : 

Feb. 8th, 1887. 

To President and Members of New York State Homoeopathic 
Medical Society : 

The undersigned Committee of Audit of Treasurer's Accounts do 
hereby report that we have examined the books and vouchers of said 
Treasurer, and find the same correct. L. A. Bull, 

II. L. Waldo. 

On motion Dr. Hiram E. Fuller, of Lansingburgh, N. Y., and 
Dr. H. P. Partridge, of Bennington, Vt., were invited to participate 
in the proceedings of the Society. 

Thirty-Sixth Annual Meeting. 31 

The report was presented by the Chairman, H. M. Paine, M. D. 

The Committee on Legislation respectfully report that they have 
endeavored to comply with the resolutions adopted by the Society last 
year, the essential provisions of which were the preservation of the 
law of 1872, providing for the appointment of State examining 
boards ; also, so far as might be practicable, to unite with the old 
school in efforts to secure the passage of a bill for better regulating 
medical practice. 

The usual attempt, was made last winter in the early part of the ses- 
sion of the legislature, to promote the passage of a Bill providing for 
both the appointment of a single board of State medical examiners 
and for regulating medical practice. 

This Bill, in the Assembly, was referred to the judiciary committee. 
This committee gave both its friends and opponents an extended hear- 
ing, and, after listening to the arguments presented by the committee 
of this Society and others, against the formation of a single State 
board of medical examiners, on the ground that thereby there would 
be created a powerful medical monopoly, composed of representatives 
of one school of medicine, promptly reported the Bill adversely, 
thereby arresting further progress for that session. 

Your committee then united with the committee of the old school 
in efforts to obtain the passage of a bill for codifying the laws of the 
State regarding the regulation of medical practice. This Bill, known 
as Senate Bill 485, passed the Senate, but owing to unexpected oppo- 
sition at the last hours of the session, failed in the Assembly. 

In order that the homeopathic profession throughout the State might 
become fully acquainted with purposes had in view, and the plans for 
protecting and perpetuating homoeopathic interests, the committee 
issued a pamphlet of sixteen pages, in which is clearly set forth the 
position held by the homoeopathic school, more particularly an extended 
argument against the appointment of single State boards of medical 

Copies of this pamphlet have been mailed to secretaries of county 
medical societies as far as their addresses could be obtained. 

The present purpose of the old school seems to be, to relinquish, for 
the present, its efforts to secure a single State board of medical exam- 
iners, and to promote such legislation regarding the regulation of 
medical practice as both schools can agree upon, the matter of simplify- 
ing and rendering more effective existing medical laws being consid- 
ered paramount to all other questions. 

32 Proceedings. 


In order to give practical effect to this purpose, a Bill, prepared by 
W. A. Purrington, Esq., of New York, has been again presented to 
the Legislature, and has already been reported favorably by the Senate. 

This Bill is substantially the same as that known as Senate Bill 485, 
of last year. A few paragraphs have been changed, and some of its 
harsher features modified. Its good qualities, in defining and estab- 
lishing a suitable standard of educational requirements, and in its clear 
and decisive bearings upon irregular practice, cannot be too highly 

This Bill, now known as Senate Bill 45, ought at once to receive the 
unqualified approval of the whole medical profession. 

A copy of the circulars issued by the committee are herewith sub- 
joined, under Appendix A, B and C. 

The expenses incurred in the publication and issuing of these vari- 
ous statements, has been in part met by members of the committee, 
and are as follows : 

For printing slips, copies of proposed medical bills, blank and 
circulars, $45.75. 

For extra copies of newspapers containing reports or references 
thereto, and postage, $12.48. " 

Toward which twenty-five dollars has been paid by members of the 
committee, leaving an unpaid balance of $33.23. 

The committee would recommend that effort be continually made 
for preserving the provisions of the Law of 1872 by which the several 
schools of medicine are now provided with examining boards of their 
own ; and also that the support of the homoeopathic school be given 
to the present Bill for regulating medical practice. 

With these purposes in view, we offer the following resolutions : 

Itesolved, That in the opinion of this Society it is desirable that the 
provisions of the Law of 1872, whereby the different schools of med- 
icine- in this State are provided with separate examining boards, 
should be preserved and perpetuated. 

Resolved, That whenever the provisions of this law are changed, 
they should be so amended as to confer upon the boards appointed 
thereunder, both examining and licensing powers. 

Itesolved, That we approve the enactment of the present Bill, known 
as Senate Bill 45, the purposes of which are the codification of the 
present laws relating to medical practice and the better regulation thereof. 

Resolved, That the committee on medical legislation be instructed 
to endeavor to carry out and render effective the purposes and recom- 
mendations herein set forth. 

All of which is respectfully submitted, 

H. M. Paine, E. S. Coburx, 

E. Hasbrouck, John J. Mitchell. 

Geo. E. Gorham, Herbert M. Dayfoot. 

Thirty-Sixth Annual Meeting. 33 


Statement Issued by the Committee on Medical Legislation of the Homoeopathic 
Medical Society of the State of New York, November, 1886. 

To the Homoeopathic Medical Profession : 

The Committee on Medical Legislation desire to call the attention of 
the homoeopathic profession of this State to the following statement : 

An effort was again made last winter, for the fourth or fifth time, to 
secure the passage of a bill providing for a single, old school State 
board of medical examiners, composed of nine members, including, for 
the sake of representation, one homoeopathic and one eclectic physician. 


The committee strenuously opposed this Bill, for the following 
reasons : 

That the creation of such a board would practically establish a per- 
manent and powerful medical monopoly of the licensing franchise, 
under the immediate control of one school of medicine, thereby con- 
stituting an exceedingly objectionable form of class legislation. 

That the consciousness of the possession of the power thereby vested 
in the representatives of the dominant school would, whether intended 
or not, operate as a constant menace upon the less numerous schools ; 
would tend to strengthen the majority, and would prove constantly 
detrimental to the growth and permanence of the schools represented 
by the minority. 

That the unequal representation therein provided for would be con- 
sidered a mark of degradation and subserviency, which would stamp 
the homoeopathic minority with a perpetual brand of inferiority. 

That the functions of the examining board being administrative, 
the basis of representation therein, of the different schools, must, of 
necessity, be equal, like that of the United States Senate, in order that 
the judicial powers of each school may be no greater than those of the 
other two. Unequal representation of the different schools in a 
single examining board, would place a premium upon favoritism. 

That no adequate provision is made for checking favoritism on the 
part of the majority which, sooner or later, would inevitably occur ; 
hence an act of great injustice would be done to the homoeopathic 
school by the establishment of a single board, on the basis proposed by 
this bill, the plan of secret examinations therein provided being open 
to many practical objections. 


34 Proceedings. 

Tliat the homceopathic students, regardless of their wishes or pref- 
erences, would be placed completely in the power of what would be 
practically an old school examining l>oard. 

That, as homoeopathists, we insist that the qualifications of homoeo- 
pathic students shall be determined by a homoeopathic examining 

That, on account of the antagonism, rivalry and jealousy existing 
between the different branches of the medical profession, one school 
ought not, by any means, to be clothed with arbitrary and irresponsi- 
ble power, such as this bill provides. 

That it will be impolitic and against public welfare to force by law 
a coalition involving important rival interests, until there are evidences 
of greater harmony between the two principal schools; and particu- 
larly not until the old school acknowledges the applicability of homoeo- 
pathic principles by adopting them in practice and teaching them in 
their own medical schools. 

That, in order to establish a sufficientlv uniform standard of attain- 
ments, a single State examining board is no more a necessity in medi- 
cine than in law or theology, in both of which an entrance into these 
professions is gained through several sources, there being no valid 
objections thereto on the ground of defective thoroughness. 

That the present law, that of 1872, authorizing the appointment of 
State boards of medical examiners, by which each school is provided 
with its own examining boards, thereby enabling it to accomplish its 
own educational work untrammeled by the presence of hostile mem- 
bers, is fully in accord with the principles of equal representation ; 
and, by its abundant safeguards, is sufficiently effective to meet the 
exigencies of public and professional requirements. 

That having originated and perfected this law, and having for four- 
teen years maintained thereunder, dissociated from unfriendly interfer- 
ence, a recognized official status ; and having complied with its 
nnsectarian and catholic provisions, satisfactorily to ourselves, and with 
careful regard for professional and public interests ; we see no good 
reason, under existing relations, for forming an alliance by which our 
school will be in a great measure deprived of the privilege of perform- 
ing its full share of educational work ; on the contrary, our experience 
establishes the conviction that professional interests and the public 
welfare will be more effectually protected and promoted by perpetu- 
ating its wise, liberal and conservative principles. 

That having secured the appointment of the first State examining 
board, and having enjoyed its advantages undisturbed these many 


Thirty-Sixth Annual Meeting. 35 

years, we are warranted in urging our old school colleagues to lay aside 
their prejudices against this admirably -arranged, equitable and effective 
law, and give it a fair and impartial trial for an equal length of time, 
before putting forth efforts to supplant it by a method, the operations 
of which would unquestionably prove destructive to their less numer- 
ous rivals. 

That in our opinion the only defect in this law is found in the fact 
that its benign and salutary provisions are voluntary one6 ; that in order 
to insure thorough effectiveness, its enforcement must be made com- 
pulsory, after a certain prescribed date, upon all who wish to enter 
upon practice in this State* 

That with this purpose in view, we will join our colleagues of the 
old 3chool in procuring such amendments thereof as will make the 
provisions of this law equally binding upon the representatives of the 
three legally recognized systems of practice ; provided such amend- 
ments shall not interfere with the appointment of separate examining 
boards for each school ; furthermore, we are free to state that, in our 
opinion, after long investigation of this subject, and ample practical 
experience, this change of law of 1872 constitutes the only needed 
reform in the matter of establishing suitable tests of medical scholar- 

That, in conclusion, we actively oppose the formation of a single 
State examining board, on account of the fact that this effort con- 
stitutes a part of a widely extended, well arranged "and systematic 
plan, indorsed by the American Medical Association, for practically 
placing the management of medical affairs, as far as is possible, 
throughout the whole country, under the direct control of one school 
of medical men ; that this pernicious system having been already 
established in several States, notably those of Alabama and Virginia, is 
now producing effects the most disastrous upon Homoeopathy, wholly- 
arresting its progress by prohibiting accessions thereto ; a most un- 
American system ; one which must be met by the most determined 
opposition on the part of all who desire to promote entire liberty of 
opinion and freedom of action among educated medical men. 

Homoeopathists do not wish to place themselves in antagonism 
to medical legislation having for its object the promotion of public 
interests ; hence do not in this instance oppose the old school bill 
without, at the same time, providing, in their opinion, a better method, 
the substitute which they offer being the present law, that of 1872. 

The application of this law has fully demonstrated the wisdom of 
its f ramers. It furnishes abundant means by which the several schools 

36 Proceedings. 

are provided with examining 1x>ards of their own selection, placed 
wholly under their own control. Its equitable and conservative pro- 
visions may he summarized as follows : 

It is equal in application: the representatives of each of the three 
schools being placed upon the same footing, no preference being shown 
to one more than another. 

Its operations are open to public inspection ; hence it is a thoroughly 
effective law. It provides abundant checks and safe-guards against 
intentional fraud on the part of the members of any board, by holding 
their action subject to the approval of the regents, and by placing all 
the evidences of the qualifications of each applicant on record for 
public inspection. 

It is a safe law, in that it cannot l>e made instrumental in awakening 
sectional jealousies, because it is purely democratic in its methods of 
application and administration. 

It establishes a uniform standard of acquirements outside the ranks 
of the profession ; hence it is an impartial law. It leaves each school 
free to exercise its own prerogatives untrammeled by the presence or 
interference of either of the others ; at the same time each board is 
held responsible for its own acts to an impartial, non-sectarian and non- 
professional court, the board of regents, who are competent to deter- 
mine and enforce compliance with a uniform and sufficiently rigid 
standard of acquirements. 

For these reasons homoeopathists are disinclined to give up a system 
which has stood the test of experience without friction, and one 
embracing within its provisions such correct forces as will forever 
render its execution practically effective and equally useful to the whole 
profession and the public. 

On the presentation of the argument, of which the foregoing is a 
summary, the committee of the Senate and Assembly promptly reported 
adversely the bill to create a single State examining board. 


This particular form of medical legislation, upon which the repre- 
sentatives of the two principal schools could not agree, having been by 
the foregoing action of the Legislature, effectually disposed of, at least 
for one year, associated effort on the part of representatives of all 
schools was concentrated upon the construction of a bill for the more 
thorough regulation of the practice of medicine and surgery in this 
State, this question being one on which all educated members of the 
medical profession are in accord. 

Thirty-Sixth Annual Meeting. 37' 

The form which resulted from this effort was known as Senate Bill 
485 and Assembly Bill 903, session of 1886. This Bill was approved 
by the Senate, but was, during the closing hours, lost in the Assembly. 

This Bill embraces within its several sections all the essential pro- 
visions of all former enactments, and in its last section repeals all laws 
or parts thereof which have any reference whatever to medical and 
surgical practice, specifying each by name, number and date, thereby 
forming a practical codification of all the laws of this State regulating 
the practice of medicine and surgery. 

Moreover, this Bill is so constructed as that, in case further legislation 
is entered upon with a view of changing the method of medical licens- 
ure, by its withdrawal from the medical colleges and placing it in 
charge of State boards of medical examiners, the second section only 
will require amendment ; all the other sections of the Bill may remain 
without alteration. 

The old school physicians who are endeavoring to change the present 
law, that of 1872, so as to provide for a single State examining board, 
are unquestionably actuated by a worthy motive, that of improving, 
unifying and elevating the standard of medical acquirements. As far 
as regards the object had in view, both schools are in accord ; homoeop- 
athists, however, object to a method which will surely tend to the dis- 
integration of their own school. They prefer a board of their own, 
and believe the people of this State will sustain them in their efforts 
to preserve and perpetuate the essential provisions of the present law. 

These statements are made at length, in order to promote intelli- 
gent, harmonious and effective effort on the part, and to secure the 
active cooperation, of the homoeopathic profession. 

The committee hope that all the county and local medical societies 
in this State will adopt resolutions approving the preservation of the 
provisions of the law of 1872 ; and also approving the passage of a bill 
for regulating medical practice, having the essential provisions of 
Senate Bill 485, session of 188ti, a copy of which will be mailed to the 
secretary of each county homoeopathic medical society. 

Copies of these resolutions, when adopted, and of newspapers con- 
taining them, should be forwarded promptly to the chairman of the 
committee, Dr. H. M. Paine, of Albany. Such evidences of approval, 
coming from all parts of the State, will greatly aid the committee, 
during the coining winter, in case effort should be made to repeal the 
law of 1872. 

The following resolutions were unanimously adopted at the semi- 
annual meeting of the State Society, held September 7, 1880: 


rhat the Homoeopathic Medical Societv of tlie State of 
ndorses tlie proposition made by the Medical Society of 
New York, as set forth by its Committee on Legislation 
i to tlie recent session of the State Legislature under 
35 ; the purpose of said Bill being the simplification and 
f the laws of th'.s State relating to the practice of inedi 
That the county and local medical societies of this State 

of the profession generally are requested to promote, to 
tent, tlie early enactment of a law providing for an in- 
<ucy of laws regulating medical practice, as embodied by 
io of the session of 1&S6. 

That this Society indorses the action of its Committee on 
11 opposing tlie passage of the bills presented to the last 
f this State, providing for tlie appointment of a single 

of medical examiners, the membership of which was 
irofessors of medical colleges and an unequal representa- 
fferent schools of medical practice. 

That this Society heartily reiterates its endorsement of 
is of the present law, that of 1872, by which the repre- 
the three legally recognized schools of medicine are now 
ed to appoint one or more examining boards under their 
; a law, the limitations of which provide all necessary 
ld at the same time prevent liability to favoritism and 
von isms sure to occur in the case of a single mixed ex- 
hat this Societ}' again, in the most positive terms, instructs 
s on Legislation to endeavor to prevent the repeal of the 
roviding for the appointment of State boards of medical 
it of 1872; also, if feasible, to endeavor to Becure an 
lereof, providing for a withdrawal from the medical col- 
State of the right of medical licensure. 


ed Bill to regulate the practice of medicine and surgery 
the following synopsis ; the first and second sections are 

igulato the Licensing and Registration of Physicians and 
:id to Codify tlie Medical Laws of the State of New York. 
I 485, and Assembly Bill 903. session of 1SS6.) 
I. No person shall practice physic or surgery in this State 
have attained the age of twenty-one years ; and no person 
as aforesaid unless he or she shall be, at the time this Act 
:ct, a person lawfully engaged in such practice in this 
;ense or authority conferred by its laws then in force, or 
le shall be licensed or authorized so to practice by the 
:his Act. 

Thirty-Sixth Annual Meeting. 39 

Sec. 2. From and af cer the date of the taking effect of this Act, no 
. person shall be deemed licensed or authorized to practice physic or 
surgery in this State, except one of the three following classes : 

First. All who shall have been graduated from an incorporated 
medical school or college in this State with the degree of doctor of 
medicine, after substantial compliance with all the requirements of the 
general laws and of the charter of said corporation regulating the term 
and amount of study, attendance and attainment requisite to obtain said 
degree ; provided that no person shall receive the degree of doctor of 
medicine, or be licensed to practice physic or surgery in this State, 
unless he shall have pursued the study of medical science for at least 
three years after the age of eighteen, with some physician and surgeon 
duly authorized by law to practice physic or surgery ; and shall also, 
after the 6ame age, have attended two complete courses of lectures in 
some legally incorporated medical school or college, in good standing 
at the time of such attendance, prior to the granting to him or her of a 
diploma or license ; provided, further, that two courses of lectures, 
both of which shall be either begun or completed within the same 
calendar year, shall not satisfy the above requirement. 

Second. All who have received said degree after substantial com- 
pliance with the requisites preliminary to its attainment, from a legally 
constituted board of medical examiners of this State. 

Third. All who, having been graduated from incorporated medical 
schools or colleges without the State as doctors of medicine, or licensed 
to practice physic or surgery under the laws of those European 
countries in which said degree does not confer the right so to practice, 
shall procure their diplomas from said corporations, or their licenses 
from such countries, to be indorsed by the faculty of an incorporated 
medical school or college within this State, or by a legally constituted 
board of medical examiners of this State. Every such indorsement 
shall be in form of Schedule A or of Schedule B of this Act. Every 
corporation or board so indorsing, shall keep a record of their indorse- 
ments, and may require applicants to verify their statements under 
oath ; any indorsement made with fraudulent intent, or gross careless- 
ness or ignorance, shall be deemed a misdemeanor, and shall subject 
the indorser or indorsers, upon conviction thereof, to a fine of two 
hundred and fifty dollars. 

Sec. 3. Provides for registration. 

Sec. 4. Provides for reregistration, on removal from one county to 

Sec. 5. Exempts all who are at the present time lawfully registered, 
from the provisions of the bill ; also provides that after October 1st 

40 . "Proceedings. 

no registration shall be considered valid except the license described 
in the second section. 

Sec. 6. Defines the meaning of the term " practice of physic or 
surgery"; states what constitutes irregular practice; and declares 
an infringement of the law to be a misdemeanor. 

Sec. 1. Excludes from practice all who have been convicted of a 
felony ; declares all who have swom falsely to any affidavit, or who 
have obtained a diploma fraudulently, to be guilty of a misdemeanor ; 
fixes the penalty therefor, and places the burden of proof of innocence 
upon the defendant. 

Sec. 8. Declares that an unlicensed practitioner shall not be able to 
collect fees by law ; permits an aggrieved party to recover twice the 
value of fees he may have previously paid for such irregular service ; 
and gives county medical societies the right to collect twenty-five 
dollars from unlicensed and unregistered practitioners for the first, and 
fifty dollars for subsequent offences, the excess over costs to be paid to 
the State Board of Charities. 

Sec. 9. Defines the exceptions from the provisions of the Act to be : 
commissioned medical officers of the army and navy, members of a 
medical or surgical staff of a hospital, dentists and physicians from 
neighboring States in consultation. 

Sec. 10. Repeals all laws and parts thereof, specifying each by 
name, number and date, enacted since eighteen hundred and six to 
the present time, which relate to the practice of physic or surgery in 
tliij State, except chapter seven hundred and forty-six, laws of eighteen 
hundred and seventy-two (and chapter six hundred and seventy-nine, 
laws of eighteen hundred and eighty-one, amendatory thereof), being 
the present law authorizing the appointment of separate State boards 
of medical examiners for the different schools of medicine. 


In all probability a Bill, modified somewhat in minor points, yet sub- 
stantially the same as the foregoing, will be introduced, and its passage 
advocated by the old school. Its essential provisions, being in the main 
founded on correct principles few members of tlte profession of either 
school will interpose any objections thereto: on the contrary, will, as 
far as may he in their power, endeavor to promote its passage. 

It is also presumable that Bills will be again introduced, at the 
approaching session of the Legislature, providing fur the appointment 
of a single State Board of Medical Examiners. This will be done for 
the purpose of separating the teaching from the licensing interests, in 

Thirty-Sixth Annual Meeting. 41 

order that the standard of medical attainments, as in law and theology, 
may be determined and established by bodies other than those who are 
interested in imparting instruction. 

If this is attempted, instead of favoring a Bill to create a single 
State examining board, the committee urgently request homceopathists 
to support a Bill amending the present law, that of 1872, thereby 
preserving and perpetuating the appointment of separate boards for 
each school of medicine. A copy of this form is herewith subjoined. 

On the other hand, if no further attempts are made to change the 
present law so as to establish a single examining board, and all effort 
at medical legislation, during the coming winter, is concentrated upon 
the Bill to regulate medical practice, the committee urge homceop- 
athists to give the Bill their united and cordial support. 

After the passage of the Bill regulating medical practice — a synopsis 
of which has been previously given — in case effort is then made to 
change the present system of granting licenses, two amendments 
will be required, in order to protect homoeopathic interests. These 
are : one to slightly modify two sections of the law of 1872 ; the 
other to change the second section of the law regulating medical 
practice, so as to provide each school with boards of its own. 

These amendments will be presented substantially in the following 
forms, which are here introduced in order that homoeopathists may be 
able to give them their active support when the time for such aid 
shall have arrived : 


Proposed amendments of two sections of the law of 1872. 

Sec. 5, Any person over twenty -one years of age, of good moral 
character, and paying not less than fifteen dollars into the treasury 
of the University, on applying to the Chancellor for the aforesaid 
examination shall receive an order to that effect, addressed to one 
of the boards of examiners, provided said applicant shall adduce 
proof satisfactory to the Chancellor of having received the degree of 
doctor of medicine from some legally incorporated medical college. 

Sec. 6. The Regents of the University, on receiving the afore- 
said reports of the Examiners, and on finding that not less than five 
members of a Board haye voted in favor of a candidate, shall issue 
to said applicant a license to practice physic or surgery in this State, 
which license shall confer all the jjrivileges and immunities and im- 
pose all the obligations and penalties now established \ or that may 
hereafter be established by the laws of this State relating to the 
practice of physic or surgery therein. 


42 Proceedings. 

Proposed amendment of the second section of the law regulating 
medical practice, the purpose of this amendment being to preserve 
and perpetuate the provisions of the law of 1S72, whereby each 
school may lie provided with its own boards of medical examiners. 

Sec. 2. From and after the first day of eighteen hundred 

and eighty , no person shall be deemed licensed or authorized 

to practice physic or surgery in this State except those who shall have 
been graduated from an ineorpo rated medical school or college in this 
State, with the degree of doctor of medicine, after substantial compli- 
ance with all the requirements of the general laws, and of the charter 
of said corporation regulating the term and amount of study, attend- 
ance and attainment requisite to obtain said degree ; provided that no 
person shall receive the degra3 of doctor of medicine, or be licensed to 
practice physic or surgery in this State, unless he shall have pursued 
the studv of medical science for at least three vears after the age of 
eighteen, with some physician and surgeon duly authorized by law to 
practice physic or surgery ; and shall also, after the same age, have 
attended two complete courses of lectures in some legally incorporated 
medical school or college in good standing at the time of such attend- 
ance, prior to the granting to said person a diploma or license ; pro- v 
vided further, that two courses of lectures, both of which shall be 
either begun or completed within the same calendar year, shall not sat- 
isfy the above require aient ; and it is fur 'her provided that, in addi- 
tion to the foregoing, said person, after having received said degree, 
and also those who have received a license to practice physic or sur- 
gery under the laws of European countries in which said degree does not 
confer the right to so practice, shall not he permitted to practice physic 
or surgery in this State, until said person shall have been examined 
and recommended by a State board of medical examiners, appointed 
under chapter seven hundred and forty-six, of the laws of eighteen 
hundred and seventy-tioo / and it is further provided* that the regents 
of the university are hereby prohibited from granting or issuing, on 
tlie recommendation of said boards of examiners^ any degree, title or 
privilege other than a license to practice physic or surgery in this 

The proposed additions and changes are printed in italics. Just 
what these are can be easily determined by a comparison with the sec- 
ond section of the Bill to regulate medical practice previously furnished 
in this circular. 

In conclusion, the committee hope that homceopathists throughout * 
the State will, during the coming fall and winter, endeavor to call on 

Thirty-Sixth Annual Meeting. • 43 

members of the Legislature from their localities respectively, and urge 

them to support the Bill to regulate medical practice, and to oppose 

any Bill or amendment designed to change the present law, that of 

1872, except as suggested in the foregoing forms, which are designed 

to render its provisions obligatory upon the representatives of all 

schools alike. 

H. M. Paine, 

George E. Gorham, Jno. J. Mitchell, 

Lester M. Pratt, Herbert M. Dayfoot, 

Selden H. Talcott, A. K. Wright, 

Everitt Hasbrouck, E. M. Kellogg, 

Asa S. Couch, Edward S. Coburn, 



To the Homoeopathic Medical Profession ; 

The purposes had in view in issuing the accompanying pamphlet 
are as follows : 

First To furnish information and to set forth the reasons for pre- 
serving the provisions of the law of 1872, by which the several schools 
are provided with their own boards of medical examiners. 

Second. In case effort should again be made to secure the passage 
of a Bill providing for a single State examining board, to exert every 
reasonable effort to prevent such legislation ; and instead, to promote 
the passage of an amendment of the present law of 1872, thereby mak- 
ing its liberal provisions compulsory upon all schools alike. 

Third. Whether the foregoing is attempted or not, the profession 
is invited to promote the passage of a Bill, similar to that of last winter 
(Senate Bill 485, session of 1 886), for the better regulation of medical 
practice, provided its construction is such as not in any manner to in- 
terfere with or rescind the provisions of the law of 1872. 

The homoeopathic medical profession are requested to preserve the 
accompanying pamphlet for future reference, and, by personal appeal 
and correspondence, request their members of the Legislature respect- 
ively, prior to, and during the approaching session, to carry out its 
benign and equitable provisions. 

They are also requested to send for copies of the pamphlet, when 
desired for distribution to members of the Legislature or others who 
may have influence in furthering the purposes intended to be secured. 

42 Proceedings. 

Proposed amendment of the second section of the law regulating 
medical practice, the purpose of this amendment being to preserve 
and perpetuate the provisions of the law of 1872, whereby each 
school may be provided with its own boards of medical examiners. 

Sec. 2. From and after the first day of eighteen hundred 

arid eighty , no person shall be deemed licensed or authorized 

to practice physic or surgery in this State except those who shall have 
been graduated from an incorporated medical school or college in this 
State, with the degree of doctor of medicine, after substantial compli- 
ance with all the requirements of the general laws, and of the charter 
of said corporation regulating the term and amount of study, attend- 
ance and attainment requisite to obtain said degree ; provided that no 
person shall receive the degree of doctor of medicine, or be licensed to 
practice physic or surgery in this State, unless he shall have pursued 
the study of medical science for at least three years after the age of 
eighteen, with some physician and surgeon duly authorized by law to 
practice physic or surgery ; and shall also, after the same age, have 
attended two complete courses of lectures in some legally incorporated 
medical school or college in good standing at the time of such attend- 
ance, prior to the granting to said person a diploma or license ; pro- 
vided further, that two courses of lectures, both of which shall be 
either begun or completed within the same calendar year, shall not sat- 
isfy the above requirement ; and it is fur 'her provided that, in addi- 
tion to the foregoing, said person, after having received said degree, 
and also those who have received a license to practice physic or sur- 
gery under the laws of European countries in which said degree does not 
confer the right to so practice, shall not be permitted to practice physic 
or surgery in this State, until said person shall have been examined 
and recommended by a State board of medical examiners, appointed 
under chapter seven hundred and forty-six, of the laws of eighteen 
hundred and seventy-two / and it is further provided* that the regents 
of the university are hereby prohibited from granting or issuing, on 
the recommendation of said boards of examiners, any degree, tith or 
privilege other than a license to practice physic or surgery in this 

The proposed additions and changes are printed in italics. Just 
what these are can be easily determined by a comparison with the sec- 
ond section of the Bill to regulate medical practice previously furnished 
in this circular. 

In conclusion, the committee hope that homoeopathists throughout 
the State will, during the coming fall and winter, endeavor to call on 

Thirty-Sixth Annual Meeting. ■ 43 

members of the Legislature from their localities respectively, and urge 

them to support the Bill to regulate medical practice, and to oppose 

any Bill or amendment designed to change the present law, that of 

1872, except as suggested in the foregoing forms, which are designed 

to render its provisions obligatory upon the representatives of all 

schools alike. 

H. M. Paine, 

George E. Gorham, Jno. J. Mitchell, 

Lester M. Pratt, Herbert M. Dayfoot, 

Seldek H. Talcott, A. R. Wright, 

Everitt Hasbrouck, E. M. Kellogg, 

Asa S. Couch, Edward S. Coburn, 



To the Homoeopathic Medical Profession : 

The purposes had in view in issuing the accompanying pamphlet 
are as follows : 

First. To furnish information and to set forth the reasons for pre- 
serving the provisions of the law of 1872, by which the several schools 
are provided with their own boards of medical examiners. 

Second. In case effort should again be made to secure the passage 
of a Bill providing for a single State examining board, to exert every 
reasonable effort to prevent such legislation ; and instead, to promote 
the passage of an amendment of the present law of 1872, thereby mak- 
ing its liberal provisions compulsory upon all schools alike. 

Third. Whether the foregoing is attempted or not, the profession 
is invited to promote the passage of a Bill, similar to that of last winter 
(Senate Bill 485, session of 1886), for the better regulation of medical 
practice, provided its construction is such as not in any manner to in- 
terfere with or rescind the provisions of the law of 1872. 

The homoeopathic medical profession are requested to preserve the 
accompanying pamphlet for future reference, and, by personal appeal 
and correspondence, request their members of the Legislature respect- 
ively, prior to, and during the approaching session, to carry out its 
benign and equitable provisions. 

They are also requested to send for copies of the pamphlet, when 
desired for distribution to members of the Legislature or others who 
may have influence in furthering the purposes intended to be secured. 

44 Proceedings. 

It is hoped that all the county and local medical societies' in the 

State will, as soon as possible, adopt resolutions approving the objects 

herein set forth, and will mail a copy thereof to the chairman or any 

member of the committee. 

Yery respectfully, 

H. M. Paine, 

Chairman of the Com. on Legislation. 


The following resolutions were unanimously adopted at a meeting 
of the Homoeopathic Medical Society, held 

Resolved, That in the opinion of this Society, public and profes- 
sional interests will be more effectually promoted by the continued 
maintainance of two or more separate boards of medical examiners, in 
order that the several schools may be untrammelled by the supervision ' 
of the representatives of opposing systems, , which an association in a 
single board necessarily involves ; also, in order that each school may 
be free to exercise its judicial and executive functions subject only to 
non-sectarian and non -professional control. 

Resolved, That to this end, we endorse the efforts made by the com- 
mittee on Legislation of the State Homoeopathic Medical Society, to 
prevent the repeal of the law of 1872, which provides for the appoint- 
ment of separate State boards of medical examiners for the several 
schools ; and that we urge the committee of the State Society to con- 
tinue to put forth all reasonable effort for the preservation of the lib- 
eral and equitable provisions embodied in this law. 

Resolved, That we hereby respectfully request the members of the 
Assembly from this county and the Senator from this district, to sup- 
port the sentiments herein expressed, by opposing all bills which pro- 
vide for a single State examining and licensing board, such enactments 
constituting an objectionable form of class legislation. 

Resolved, That we also heartily endorse the sentiment approved by 
the University Convocation, at its last annual session, to the effect that, 
u In the judgment of this Convocation, the power to license physi- 
cians should be vested in boards of examination different from facul- 
ties of medical instruction : " hence we recommend an amendment of 
the law of 1872, which, while preserving its requirements regarding 
the appointment of separate boards for the several schools of medicine, 
shall also provide for the withdrawal from the medical colleges of the 
right to grant licenses to practice medicine or surgery in this State 
(the colleges being private institutions); thereby placing the licensing 
power where it properly belongs, under the control of the profession, 
in charge of licensing boards created for that purpose. 

On motion the report was accepted and the recommendations adopted. 
No report was presented from the Committee on Medical 

Thirty Sixth Annual Meeting. 45 

The report was presented by M. O. Terry, M. D., Chairman. 

Statistics of the State Homoeopathic Asylum at Middietown, Orange Co., N. Y., 

for the year ending September 30, 1886. 

Patients remaining in Asylum, Sept. 30, 1885, 
* Admitted within the year, - 
Whole number of cases treated within the year, 
Number discharged within the year, - 
viz : as recovered, - . - 


unimproved, - 
Deaths, - _..... 
Patients remaining Sept. 30, 1886, 
Maximum number within the year, 
Minimum " " ik - 
Daily average, 

Percentage of recoveries on number discharged, 
Percentage of deaths on number treated, - 




































Report for 1886 of Homoeopathic Hospital, W. I., New York. 

Dear Doctor : 

I send you herewith report of our hospital for 1886 : 

Whole number under treatment, 

Number discharged — Cured, • - 1,487 

Improved, - - - 1,399 

Unimproved, - 176 

Died, ------ 279 




[Remaining January 1st, 1887, ----- 
Mortality 7.47 per cent. 

Of this number 2,104 were in Medical Wards. 

1,239 " Surgical Wards. 
119 fcfc Erysipelas Wards. 
65 " Gyn ecological Wards. 
136 " Venereal Wards. 
70 " Ophthalmic Wards. 
45% of deaths were from Phthisis, in various forms. 
7.8% u " Pneumonia. 

10% ib " Heart troubles. 

20% " " Kidney diseases. 













46 Proceedings. 

Since September, 1875, 1,137 cases of Erysipelas have been under 
treatment at this hospital Of this number 31 have died, or a mor- 
tality of 2.7 per cent. 

Yours fraternal] v, 

T. M. Stbono. 


The Committee to whom was referred the address of the President, 
delivered at the Annual Meeting, Feb. 8, 1887, would respectfully 
report : ' 

That we are in full accord with the suggestion of the President as 
to the propriety of still adhering to our organizations, both State and 
National, having a hope, however, that the time may arrive when, 
without betraying the trust, as guardians of the great law of nature, 
which we have organized ourselves to develop and sustain, we may 
enter into a larger and nobler union, where the only aim shall be 
the evolution of truth, and the uniting of ties in the great brother- 
hood of medicine. 

The Committee also suggest that the Society approve the recom 
mendation of the President that the Transactions of the Society be 
published in two parts, to be bound in paper, immediately after the 
semi-annual, and annual meetings, respectively, and that the license 
given to the writers of papers read before the Society, to print them 
elsewhere than in our Transactions, be rescinded, and that hereafter 
they be the property of the Society. 

While it is undoubtedly true that the work of the secretary is. 
laborious and unquestionably deserving of the very proper remunera- 
tion that it has hitherto carried, still, in view of the state of our 
finances as exhibited through our treasurer, we recommend that for 
the present the office of our secretary be not a salaried one. 

Further than this, the Committee fully sympathize with the Presi- 
dent in his remarks as to liberty of professional action, and tender him 
our thanks for his earnest efforts in our behalf during his administra- 
tion, by his public utterances. 

J. J. Mitchell, 

E. Hasbrouck, 
George E. Gorham. 

Report received and recommendations adopted. 

Thirty-Sixth Annual Meeting. 47 


Dr. Anna C. Howland presented the following report : 

The Twenty-Second Annual Session of the Homoeopathic Medical 
Society of Pennsylvania, was held in Philadelphia, September 
20th-23d, 1886. The ceremonies attending the formal opening 
and dedication of the new building of Hahnemann College, occupying 
the rest of the week. The sessions which were held in the new col- 
lege building were well attended throughout by physicians from all 
parts of the State, who mainly devoted the entire week to the meeting. 

Contrary to the notions of most New Yorkers, the Pennsylvanians 
firstly disposed of the business part of the meeting in short order, 
leaving only the election of officers until the last session, and then 
spending very little time on that. 

The rest of the sessions were wholly devoted to ^he reading of 
exceedingly interesting and practical papers, which were received with 
attention and actively and intelligently discussed. 

Every bureau presented 6ix or seven papers. Almost none were 
read by title only. 

The deliberation and careful attention given to matters of the 
most importance in meetings of this kind, viz,, the reading and dis- 
cussion of papers, forms an example by which any of the State Socie- 
ties in my acquaintance might profit. Your delegate was received 
with marked cordiality and courtesy. 

The new college building on Broad Street is an extremely handsome 
one, and furnishes many facilities hitherto impossible in the old quar- 
ters of the College. Respectfully submitted, 

Anna C. Howland. 

A communication was received from Dr. D. B. Whittier, of Fitch 
burg, Mass., returning thanks for his election as an honorary member 
of the Society. 


Presented by A. W. Holden, M. D. 

Albany, February 8th, 1887. 
I beg permission to report by title the following names of record for 
the necrological report for the past year, namely : 

Dr. Thomas J. Pettit, of Fort Plain, N. Y., March 3, 1886. 
Cornelius Ormes, M. D., of Jamestown, N. Y., April 20, 1886. 
C. M. Lawrence, M. D., of Port Jervis, N. Y., Sept. 30, 1886. 
Carl T. Liebold, M. D., of New York City, Nov. 30, 1886. 

48 ■ Proceedings. 

If any of the members present should be cognizant of the death of 
any member of the State Society during the past year, not here 
mentioned, they will confer a favor by reporting the same with sufficient 
data for a biographical sketch to A. W. Holden, M. D., at Glens Falls, 
N. Y., immediately. 


In the absence of the Chairman, the report was presented by Db. 
H. M. Paine. 

The committee appointed to enter upon tests of high attenuations, 
would respectfully report that on approaching the subject, they found 
difficulty in formulating any plan of work that could be easily made 
practical, commend itself to the profession, and give decisive results. 

In common with a similar committee of the Western New York 
Homoeopathic Medical Society, we took time to discuss the subject 
carefully, in all its respects. f 

In the Autumn, the committee issued a circular to the profession, 
through three or four prominent homoeopathic journals, and later on, 
another circular with blanks asking the cooperation of the profession 
individually, in filling out these blanks as proper cases occur. 

As far as addresses were attainable, each homceopathic physician in 
New York and several outside the State, have been supplied with 
these blanks, hence it is not necessary to repeat their substance here. 
This subject is a matter of vital importance to homoeopathy and should 
command the active support of every homoeopath ist in the State. 

The few answers to circulars received up to this time would be of no 
benefit in a report, without the hundreds that we expect to receive in 
the next year or two. 

As Drs. A. W. Dods and W. C. Latimer have taken an active part 
in the work of this committee, we would propose that they be 
formally added to the committee by a vote of the Society. 
Respectfully submitted, 

A. R. Wright, 
H. M. Paine, 
T. L. Brown. 

On motion, the report was received and committee continued, with 
the addition of Drs. W. C. Latimer and A. W. Dods. 



Thirty-Sixth Annual Meeting. ±\) 



The Committee on Regents' Degree presented the following report, 
which was accepted : 

Mr. President: 

Your Committee beg leave to report that they have carefully con- 
sidered the statute authorizing this Society to make nominations for 
the Regents' Degree, and in their opinion the degree is designed to be 
wholly honorary in character. This view is based upon Chapter 
268 of the Laws of 1862. page 1101 Revised Statutes (new edition), in 
which it is expressly stated that this degree shall not permit its holder 
to practice either physic or surgery. This is consonant with the 
following by-law, adopted by this Society at its regular meeting in 
1876 : 

"Resolved. That the Regents' Degree of the University of the 
State of New York be couferred only upon gentlemen of eminence 
in the profession." 

F. Park Lewis, Chairman. 

No report was received from the Bureau of Materia Medica. 
In the absence of the Chairman, the Secretary presented the 


{For papers and discussion see bureau report.) 

On motion, Dr. Gortqn was given permission to publish his paper 
in one of the journals, in advance of its appearance in the Trans- 

On motion of Dr. Coburn, Dr. L. R Wells was placed upon the 
list of Senior Members, with dues remitted. 

The resignations of Drs. O. E. Pratt and Anna C. IIowland were 

The following being live years in arrears, were dropped from the 
roll : Drs. E. J. Morgan, Jr., John S. Linsley and Joseph Finch. 

On motion of Dr. Moffat, the names of Drs. A. S. Ball, of Kew 
York, and D. II. Eullard, of Glens Falls, were placed on the list of 
Senior Members. 

Dr. E. Hasbrouck, Chairman, presented the 


(For papers and discussion see bureau report.) 



L 1 B p£J> / EvEXI>'G SESSION. 
H. L. Waldo, M. D., Chairman, presented the 


{For papers and disc tension see bureau report.) 

No reports were received from the Bureau of Otology and Z'ced- 

No report front the Bureau of Gynieeoloyy. 
No report from the Bureau of Vital Statistics. 

SECOND DAY— Wednesday. , 

Society called to order ;it ID a. si. President Houohton in the 

Dr. F. Park Lewis presented the 


(For papers see bureau, report.') 

Geo. M. Dillow, M. D., Chairman, presented 


[For papers and discussion see bureau report.) 
No report from the Bureau of Climatology. 


The tellers announced that the following had been elected to the 
respective offices : 

President — II. M. Paine, M. D., Albany. 

1st Vice- President — Wm. Tod IIelmutii, M. D., New York City. 

2nd Vice-President- — J. SI. Lee, II. D., Rochester. 

3rd Vice-President— G. E. Gobhaji, M. D., Albany. 

c- -Heruekt M. Daykoot, II. D., Rochester. 

-E. S. Coburn, M. IX, Troy. 


District — Drs. H olden, Pearsall, Laird. 
District — Drs. Doughty, Hasbrouck, Norton. 
istrict — Drs. Terry, C. E. Jones, Vincent. 
district— Drs. Couch, Osborne, Wolcott. 

Thirty-Sixth Annual Meeting. 51 

On motion, it was voted that all necessary expenses of the office 
of secretary be paid by the Society and that the secretary be requested 
to make the expenses as low as possible. 

J. M. Lee, M. D., Chairman, presented the 


{For papers see bureau report.) 


The Committee reported the names of Profs. Wm. Tod Helmuth, 
M. D., and Henry C. Houghton, M. D., as candidates for this degree, 
and on motion, they were duly elected. 

On motion, New York City was selected as the place for holding the 
Semi- Annual Meeting, and the 20th and 21st of September as the time. 

Drs. Helmuth, BEEBE'and Houghton were appointed a local com- 
mittee of arrangements for the Semi-Annual Meeting. 

The Committee on Chairmen of Bureaux reported the following, 
which was accepted : 

Committee on Legislation : Geo. E. Gorham, M. D., Albany. 

" Medical Education : Chas. A. Bacon, M. D , New York City. 

" Societies and Institutions: M. O. Terry, M. D., Utica. 

Bureau of Materia Medica : Geo. M. Dillow, M. D., New York City. 
" Ophthalmology : A. B. Norton, M. D., New York City. 
" Mental and Nervous Diseases: Selden II. Talcott, M. D., Middletown. 
" Histology : Fred S. Fulton, M. D., New York City. 
" Obstetrics: Louis Faust, M. D., Schenectady. 
'* Clinical Medicine : II. L. Waldo, M. D., West Troy. 
Otology: L. M. Pratt, M D, Albany. 
Predology : W. C. Latimer, M. D., Brooklyn. 
" Laryngology: L. A. Bull, M. D., Buffalo. 
" Surgery: J. M. Le «-, M. I)., Rochester. 
44 Gynaecology : F. F. Lmrd, M. D., Utica. 

Vital Statistics : A. R. Wright, M. D., Buffalo. 
" Climatology : C. E. Jones, M. D., Albany. 

On morion, a set of the Transactions was granted to the Hahne- 
mannian Society of the Homoeopathic Medical College of New York. 

On motion, the publishing committee was directed to include in 
the coming semi-annual report, the president's address, together with 
the minutes of the last semi-annual meeting, and the proceedings and 
papers of the present session. 

On motion, a vote of thanks was extended to the president and 
secretary for the prompt and efficient discharge of their duties, 
and to the members of the Council of the city of Albany for the 
courtesy extended to the Society in granting them the use of the 
Council room. 


52 Bureau of Mental and Nervous Diseases. » 




Samuel Lilienthal, M. D., Chairman^ - - New York City. 

Drs. S. H. Talcott, Middletown. 

A. P. Williamson. ----- Middletown. 

C. Spencer Kinney, - Middletown. 
F. S. Armstrong, - - Binghamton. 

D. A. Gorton, ----- Brooklyn. 
Wm. M. Butler, ----- Brooklyn. 



By David A. Gorton, M. D., 


As to the necessity of asyhims for the insane there can be no two 
opinions. But as to the propriety of sending every insane person to an 
asylum there may be a difference of opinion. Under the system of 
management now in vogue, though greatly improved over any former 
system, for not long since insane asylums were merely institutions for 
restraint and confinement of insane persons, it is a matter of fcoubt if 
the highest degree of utility in the care and treatment of persons 
suffering from any form of insanity is reached by them. On general 
principles it must be conceded to be an error to herd diseased persons 
together, whether it be persons suffering from brain disease, or any 
other form of disease of grave nature — except it be in cases of the 
hopelessly diseased — not only because the moral influence of such 
diseased persons is bad upon each other, but also because the disorder 
itself is aggravated thereby. Not to speak technically on this subject, 
we may regard an insane person as suffering from infection. His 
general condition is disordered. He is a walking morbus and a center 
of morbific causes and impulses which are, in a measure, communicable 
to others. 

\ / 

Bureau of Mental and Nervous Diseases.. 53 

We are too prone to regard a person whose mind is disordered as 
possessed of an anomalous affection. Nothing is further from the 
truth, in most cases. In a large majority of cases insanity is nothing 
but the mental effect produced by a general disorder in an individual 
possessed of undue nervous susceptibility — or what is technically 
known as an insane neurosis. The general health of such a person has 
declined under the stress of ordinary morbific causes, and the bodily 
functions have become impaired, and the brain receives the stress of 
it. Perhaps it may be the liver that is at fault, or the kidneys ; or the 
proximate cause may lie in the stomach, the lungs, heart or the sexual 
organs ; not infrequently the cause is associated with defective function 
of the skin, an instance of which we give in the report of a case sub- 
joined herewith. But whatever the proximate cause or causes may be, 
the general constitutional symptoms do not fail to reveal them in any 
given case of mental disease. The excretions are morbid in every such 

Melancholia, for example, is usually traceable to disordered secretion 
of the liver, and we believe properly so, for the biliary secretion is 
abnormal ; but it is generally also associated with defects of the 
functions of the skin, as seen not only in the yellow color of the skin, 
but also in the absence of perspiration, or in the presence of morbid 
sweat. Many persons suffering from pronounced melancholia have 
come under my observation whose skin was as dry as parchment and as 
rough as sand-paper, to whom a perspiration was an unknown phenom- 
enon. The odor of their persons would nevertheless be fetid. In such 
cases the restoration of the skin function is usually followed with 
perfect relief of the mental disorder. So great, in fact, is dependence 
of a sound mind upon a sound body that an unsound mind in a sound 
body would be a strange phenomenon. 

The celebrated writer and alienist, Griesinger, distinctly declares that 
we shall find by due investigation that " nearly the whole pathology of 
mental disease consists of mental perversions originating from internal 
organic causes; and these perversions, in turn, give rise to insane ideas 
conformable to the new mental disposition, and over which the most 
various circumstances exert an influence." {Mental Pathology and 
Therapeutics, p. 24.) And the same writer elsewhere observes, with 
pertinent force, that " brain affections which lie at the root of mental 
diseases are infinitely more frequently diffuse than localized." (Ibid, p. 6.) 
So, likewise, he says, speaking of the treatment of disease of the mind, 
that in no case of disease is " the desideratum strictly to keep in view 
the individual of greater importance than in the treatment of insanity ; 


54 Bureau of Mental and Nervous Diseases. 

nowhere is the constant consciousness more necessary that it is not dis- 
ease, but an individual patient ; that it is not mania, but an individual 
who has become maniacal, that is the object of our treatment." (Ibid. 
p. 4G4. ) Thus does this great writer and acute observer distinctly 
assign mental diseases to the category of physical disease and enunciate 
the same lucid doctrine as to the method of their investigation and 
treatment. The doctrine, though not new to-day, is deserving of being 
newly presented to the profession in general and to alienists in partic- 

Diseases of the mind are, therefore, physical diseases, while at the 
same time they are mental, and must be classified in the category of 
morbific phenomena along with other bodily diseases. The laws of 
cause and sequence are as operative with them as with all the disorders 
of the bodily life. Nor do the pathology and therapeutics of insanity 
differ, in principle^ method of investigation, or curative procedure, 
from the pathology and therapeutics of diseases in general. The phy- 
sician who is, therefore, properly qualified to investigate the nature of, 
and to prescribe for, diseases of the lower organs of the body, is equally 
well qualified to investigate and treat diseases of the organ of the mind. 

It is idle to discriminate between parts and functions of the bodily 
powers and processes, and to claim full knowledge in respect of some, 
and complete ignorance in respect of others. Body and mind are one, 
and he who is familiar with one is acquainted with the other, and he 
who is ignorant of the one does not possess full knowledge of the other. 

Holding this doctrine as firmly as we do, we have all along resisted 
the tendency of the profession to drift into specialisms in any depart- 
ment of therapeutics. For the same reason we have been opposed to 
the policy of sending persons suffering from brain disease to asylums 
for treatment so long as they could be properly taken care of at home in 
the hands of the family physician. In general, he is the better custo- 
dian of the case, if he be at all familiar with psychical disorders, as he 
knows its natural history and is acquainted with the constitutional 
peculiarities, idiosyncrasies of, and the remedies, sanitary measures, etc., 
the more likely to be suitable to the patient. Moreover, it must not be 
forgotten, as Griesinger himself admits, " that the greater number of 
insane do not require the confinement of an asylum ; that many of them 
can safely be treated with more liberty than these institutions allow, 
and that association in the family life is very beneficial to many insane 
patients." — Mental Pathology and Therapeutics, p. 470. 

To deprive a person of his liberty and confine him to the society of 
lunatics simply, and for no other reason than because his brain has lost 

Bureau of Mental and Nervous Diseases. 55 

its balance or function, may be inflicting a double wrong. Such cases 
are often as harmless as doves and as tractable as lambs, on whom the 
restraint of an asylum would operate disastrously. Dr. Henry Maud- 
Bley declares that from his own experience he cannot help feeling 4i that 
one effect of asylums is to make some permanent lunatics. Continually 
living in the atmosphere of the worst lunacy, certain patients seem to 
become impregnated with its baneful inspiration, and, after a time, 
sink to the situation. And I certainly call to mind," continues this 
lucid writer, " more than one instance in which I thoroughly believe 
that the removal of a patient from an asylum was the salvation of his 
reason." {Physiology and Pathology of the Mind. First edition, p. 
432.) The celebrated August Comte may be mentioned as a notable 
instance of this, in point. 

Such cases are exceptions, it may be said. But they are numerous 
and deserving of notice. We concede that with most cases of insanity 
home-treatment is impracticable. But deducting these cases, embrac- 
ing the intractable and over-violent, the destructives, the suicides, the 
homicides, and that large class of the insane who are unable to afford 
the expense of being treated at home or privately, the remainder of 
the insane would be infinitely better off under the care of their own 
physician, in their own homes, the enjoyment of their freedom, and in 
the society of their family and friends. Personal liberty is of such 
priceless importance to anyone possessing brains enough to become 
insane as to drive him mad who is deprived of it. 

As great as the advantage of a non-restraint life is to an insane per- 
son, there is another connected with it of still greater importance to 
him ; he is in a sane moral atmosphere, exempt from the baleful influ- 
ence of the society of the insane, which, as Dr. Maudsley says, often 
serves to make permanent a case of slight gravity. Would you cure a 
person of an infectious fever environed by an atmosphere of infection ? 
Just as rational is it to undertake to cure a mind diseased in an envi- 
ronment of lunatics. It is of signal advantage to one suffering from 
a disordered mind to be associated with rational persons, and to be 
dissociated from those who are suffering in a like or similar manner to 

Another consideration in the therapeutics of insanity, and which is 
too lightly regarded, is the importance of individual treatment of a 
person whose mind is diseased, No method of treating any disorder 
— much less that of insanity — can possess any claims to be regarded as 
scientific which does not comprehend that of individualizing every case 
under observation. The graded, or secundum artem method in treat- 

56 Bureau of Mental and Nervous Diseases. 

ing the sick — such as is pursued in the asylums and hospitals of the 
old school, and is altogether too prevalent in those of the new 
school — will not satisfy the principles of enlightened therapeutics 
in the treatment of the insane, to-day. As Griesinger has pointed out, 
it is a person whose mind is diseased that is the proper object of med- 
ical treatment, rather than a case of mania or insanitv. But in insti- 
tutions for the care of the insane, such a discrimination is impractica- 
ble. The attending physician has not the time at his command to 
study the symptoms and complications of each case and adopt a plan 
of treatment conformable to the result of such a stud v. He has too 
many patients under his charge for such a procedure. A course that 
has been efficacious in one case must be applied to all similar cases. If, 
for example, a certain nudicament has been found efficacious in quiet- 
ing the wild restlessness and irritability of one maniacal subject, it is 
apt to be prescribed to others, on purely empirical principles. As in 
hospitals, so in the asylums. Empirical formulas are adopted for each 
class of cases ; the results appear in the records, most carefully kept, 
and iigure in the reiurns — in the statistics of percentages of deaths and 

In home-treatment, on the other hand, it is possible to give the 
patient the benefit of a scientific method — that of special individual- 
ization. We say it is possible, although we know that such discrim- 
ination in private practice is not always a reality, so easily does one fall 
into empiricalism. The home physician is not likely to have so many 
cases under advisement at the same time as to preclude his giving all 
needed attention to each case. Should lie fail to do so, the failure 
would be due to ignorance or indolence, rather than to lack of oppor- 
tunity, for which state of things the friends or guardian of the patient 
would be answerable equally with the physician ; for surely, there is no 
excuse to-day for the employment of ignorant or unskillful physicians. 

This brings us to one of the chief embarrassments that beset the 
home-treatment of the insane, namely, the incompetency or aversion, 
or both, of the average general practitioner to deal with mental mala- 
dies. This state of things has led to an anomaly in practice, which, while 
natural and inevitable, is nevertheless greatly to be deplored — the rise 
of a class of specialist in mental diseases. Specialism in the therapeu- 
tics of insanity has come, but we cannot believe that it has come to 
stay. It has no reason to be except for the fact of the defective edu- 
cation of ph} r sicians. With the correction of this evil, specialism will 
have to go along with other ill-shapen creatures of misconception and 
darkness. Some of our most prominent physicians — physicians pos- 

Bureau of Mental and Nervous Diseases. 57 

sessing large followings and having large experience in general practice 
— make no attempt to conceal their ignorance of mental diseases, but 
boldly disavow all knowledge of them. As unfortunate as such a con- 
fession is, it is still more unfortunate that there should be intelligent 
physicians who regard ignorance on such a subject as no drawback to 
professional standing. It is, though, all the same. We cannot but 
regard it as a serious evil, for the existence of which the college cur- 
riculum must bear the responsibility. Let us hope, for the sake of 
humanity and mental sanity, that the day is not distant when a Doctor 
of Medicine may be equal to all the demands of his high calling, and 
especially that he may be fitted to minister to a mind diseased, which 
is the highest achievement of the medical art. 

We conclude our observations on this subject by submitting a con- 
densed report of 

a case of acute melancholia. 

We select f rom our experience in private practice this case of acute 
melancholia, to illustrate the phenomena of mental derangement from 
perversion of the lower bodily functions, and the success of home 
treatment therewith : S. M., set. 31, blonde, unmarried, temperament 
nervous. The young man was a devoted churchman, amiable disposi- 
tion, of good habits and exemplary life, but with melancholic antece- 
dents. His surroundings were congenial and happy. With the 
exception of business anxiety, which was of no unusual character 
among men of business, there seemed to be no mal-environment in 
the aetiology of the case of sufficient moment to induce melancholia. 
Nevertheless the attack came on. 

Before consulting us lie had been treated by the physician of his 
family to a course of Mercury, Quinine, Iron, Strychnine and the 
bromides. Receiving no benefit from this, he consulted an alienist, 
who prescribed a similar course of medication, and advised travel, 
which were taken. His condition, however, continued to grow worse, 
when, about six months from the beginning of the attack, he was 
induced reluctantly to place himself in our charge. 

We found him profoundly melancholic. Physically, there was 
evidence of passive congestion of the liver. The skin was of a 
yellowish color and dry — dry as parchment. There was constipation. 
The urine showed the presence of bile pigment and seminal matter, 
but was not albuminous. The appetite was capricious. There was 
insomnia — chiefly after midnight. The temperature was usually one 
degree above normal in the morning, the hour that we saw him. 

5S Bureau ok Mental and Nervous Diseases. 

Psychically, the patient was a great sufferer. He seemed enveloped 
in a dense cloud of despondency. The powers of the unconscious 
were greatly depressed. From being amiable and cheerful, he had 
become taciturn and morose. He longed for death and had suicidal 
impulses. From being a man of correct speech and pious impulses, 
he had frequent attacks of irrational anger, during which he became 
profane — weeping, lamenting and swearing by turns. 

The nights of this patient were horrible. After the first sleep he 
usually woke in a wild frenzy of despair — presenting psychical symp- 
toms not unlike hvsteria. He had dread of solitude, and was constantlv 
tormented with a sense of regret for something he had done or had 
left undone. The impulse of 6elf-destruction was most marked in the 
morning, to control which he was constantly watched by his faithful 
mi roe. 

The treatment to which we subjected him consisted of Chloride of 
Mercury in \ grain doses, every four hours for three days ; after which 
the same in l-50th grain doses four times a day, continued until some 
effect of the drug was manifest in the stools ; after which Chamomilla 
in tincture was given ; the latter was followed by Sulphur, 1st centesi- 
mal potency. As an adjuvant or supplement to these medicaments, 
Turkish baths were prescribed, at first, two a week ; later one a week. 
The influence of the baths was most marked, in relieving the mental 
depression and in promoting rest and sleep — an effect which was due. 
it is rational to believe, to the favorable influence of the baths upon the 
function of the skin, which in this case, as in manv similar cases under 
my observation, was suspended. Be that as it may, the patient made a 
good recovery, and homoeopathy gained a new convert and advocate. 

Bureau of Mental and Nervous Diseases. 59 

The Practical Treatment of the Insane. 

By Selden I J. Talcott, M. D. 


The insane must be cared for either at Lome or in suitable asylums : 
or else they must be neglected and allowed to wander in the woods 
and mountain fastnesses, as thev were at the time when the Healer of 
Gennesaret performed his mighty mission. So long as the patient is 
not dangerous to himself or others, so long as he or his friends have 
the means and the willingness to employ ski J led nurses and able physi- 
cians ; so long as the causes of insanity do not rest almost entirely 
upon the irritations of his home surroundings, the insane man may be 
cared for in his own home, or he may be looked after and maintained 
in a private family, which is not his residence. But if the patient 
becomes dangerous to himself or others, if his financial abilities fail, if 
the exciting causes of insanity may be traced to the hardships of 
business, the cares of every-day life, or to the frictions which some- 
times arise at home by reason of incompatibilities or vexatious 
burdens; if such care and treatment as are most likely to promote 
recovery cannot be secured at home, then the patient may be 6ent to 
an asylum where he may be at least maintained at reasonable cost, and, 
if possible, cured, at the minimum expense, either to the public or to 
his friends. 

The honor of establishing the first asylum for the insane in the 
world is due to the monks of Jerusalem, who in the sixth century 
built a refuge and a home for the insane dwelling at the far East. 
Southwestern Europe received its first asylum at the hands of a 
begging monk, in, the fourteenth century. This monk was moved to 
pity for the insane by seeing these unfortunates running about without 
care or comfort, in the streets of Valencia, in Spain. To the Quaker 
Christians of England is due the honor of improving the condition of 
the insane, by converting madhouses into asylums for care and 

Wherever the light of the Gospel has penetrated the darkness of 
sin and crime, there, in the light, and among the brightest and most 
conspicuous evidences of Christianity, we find the towering walls of 
asylums for the care and cure of the insane. 


60 Bureau of Mental and Nervous Diseases. 


Whoever seeks to decrv these institutions, whether influenced bv 
personal spite, or greed for personal pelf, is an enemy to the teachings 
of the Golden Rule. Whoever seeks to upbuild, to maintain, to 
improve, and to promote the best interests of asylums for the insane, 
is doing a work which would do honor to the memory of a John 
Howard, of a George Peabody, a Florence Nightingale, or a Dorathea 

Nowhere in this world have insane asylums been built with greater 
care, and nowhere has success in the treatment of the insane been 
more manifest, than in these United States. Every State has its 
asylum, and some of them have several, for the care and cure of this 
most unfortunate class in the community. Millions of dollars have 
been wisely, yet liberally, expended in this and other States for the 
purposes aforenamed ; and the wisdom of the statesman continues to 
respond to the demands of the people. 

The laws for the protection of the insane have been thoroughly 
investigated, and in this State carefully codified ; and in these laws we 
find rules for the admission, retention, and discharge of all classes of 
the insane. No man can restrain a lunatic outside of his own home in 
any private house or in any asylum, unless that patient is duly com- 
mitted according to law. No asylum can be opened until it has been 
duly incorporated, and recognized by a special law. And no private 
house can be used for the special detention and care of a lunatic* 
unless that house has been first inspected and approved by the State 
Commissioner in Lunacy, and a license granted by him. Whoever 
treats a lunatic other than in accordance with the foregoing provisions 
i« a law-breaker, and liable for damages for false imprisonment in 
every case. 

Many other States have made similar laws as those which are now in 
vogue in the commonwealth of New York. 

The measures for placing the insane under care and treatment 
having been briefly explained, the next question arises : u What shall 
be the treatment of those suffering under the visitation of insanity ?" 

Wherever it is practicable, the insane person should be afforded the 
benefits of a change of climate ; that is, those who have lived and become 
insane in the valleys, in large cities, and along the sea-shore, should 
be afforded the benefits of mountain air and inspiring scenery ; while 
those who have come to suffer with insanity while living in mountain 
regions, should be made to try the effects of the atmosphere and the 
inspirations of the untiring, ever-changing, and constantly resounding 

Bureau of Mental and Nervous Diseases. 


The insane should be placed in buildings which are, from a sanitary 
point of view, above reproach. Fresh air should be constantly fur- 
nished, and even temperature always maintained. To accomplish these 
ends, the rooms should be large and the facilities for changing the air 
frequently should be secured, and the heating of such rooms should 
be by steam or by hot water, thus avoiding the irritations and the 
dangers which arise from stoves that are constantly emitting more or 
less the gases and other impurities from coal. 

The personal measures to be adopted for the insane are, first, gentle 
discipline, attended always by invariable kindness ; secondly, rest ; 
thirdly, exercise ; fourthly, diet ; fifthly, mental and moral hygiene ; 
and, sixthly, medicine. 

Samuel Hahnemann recognized the necessity for kindness in his 
treatment of Klockenbring, the celebrated Secretary of the Chancery 
of Hanover. The immortal Hahnemann declared : " I never allow any 
insane person to be punished by blows or corporeal inflictions, since 
there can be no punishment where there is no sense of responsibility. 
The physician of such unfortunate creatures ought to behave so as to 
inspire them w T ith respect, and, at the same time, with confidence. He 
should never feel offended at what they do, for an irresponsible person 
can give no offence. " 

The suggestions of Samuel Hahnemann are the key-note for treat- 
ment in all cases of insanity. 

It is difficult to meet insane people and listen to their torrents of 
abuse sometimes, and still maintain an even temper. But if the person 
caring for a lunatic remembers always the irresponsibility of the 
patient he may then bear a serene front in the midst of terrible insane 

The insane are always sick. Therefore they always need the treat- 
ment w T hicl vis commonly accorded to sick people. Under the influ- 
ence of insanity the usual tendency is to undue excitement, and to 
undue physical activity. 

If the patient is wasting in physical strength under the encroach- 
ment of his disease, he should be made to rest. He should obey Mac- 
beth's command to Seyton : u Get thee to bed ! " And he should stay 
there until the excitement has subsided, the irritations of disease have 
been allayed, and the process of recuperation, both physical and men- 
tal, has been thoroughly inaugurated. Then he may begin once more 
the normal activities of life. These, however, should be resumed with 
that caution which is enjoined by the old Latin saw, "Festina lente " — 
make haste slowly. 

62 Bureau of Mental and Nervous Diseases. 

During the process of rest especial attention should be given to the 
administration of diet. The insane bear, as a rule, large quantities of 
liquid food. It has been our custom to administer liquid food, to weak 
cases, once in three hours, from 6 a. m. to 9 p. m. Milk and beef 
tea, the one as a nourishment and the other as a stimulant, seem to 
make a happy combination in the diet of the insane. For solid food 
at the outset, toasted bread, baked potatoes, and boiled rice or oatmeal 
are all that may be necessary. As soon as a practical gain in weight 
has been accomplished, then the patient may indulge in full quantities 
of such food as he likes best, and such as agrees best with his physical 

Rest and diet having been administered under the daily watchful 
care of a good physician, until a positive gain has been made, then, by 
his orders, the resumption of ordinary exercise may be slowly but suc- 
cessfully carried on. During the long, tedious period of recuperation 
there may come, first, the study of pictures, the reading of light peri- 
odicals, and short conversations with friends. Each day of convales- 
cence may bring an added privilege, until one may read a book, or 
take a stroll with a trusted nurse or with a judicious friend. 

The medical treatment of the insane under the homoeopathic plan 
has been pursued in one of the asylums of this State for a baker's 
dozen of years. That experiment has been eminently successful. There 
has been a gradual increase in the recovery rate, and a decrease in the 
death rate, at the institution at Middletown; until, during the year end- 
ing September 30, 18St>, we find the recovery rate 50.95 upon the 
whole number discharged, and the death rate 2.99 upon the whole 
number treated. 

In looking over the records of an asylum which has been established 
more than forty years, in this State, we find that in the most favorable 
year in the history of that institution there has not been a death rate 
as light as that which was gained during the past year at Middletown. 

The causes which have produced these results have been very 
briefly outlined in this paper for the benefit of this Society. In addition 
to the means already described, we have used homoeopathic remedies, 
applied according to the doctrine Similia Siinilibus Cnrantur, and 
we have used no other medical treatment among our patients. So long 
as the results are better than those obtained by our allopathic 
brethren, there can be no temptation to return to the " flesh-pots of 

The remedies most frequently applied for the cure of the insane are : 
Aconite, Arsenicum, Belladonna, Hvoscyamus, Stramonium, Veratrura 
album, and Veratrum viride. 

Bureau of Mental and Nervous Diseases. 63 

A second group, of perhaps a little less importance, are : Baptesia, 
Bryonia, Cantharis, Chamomilla, Cimicifuga, Ignatia, Natrum muri- 
aticum, Pulsatilla, and Sulphur. 

These are some of the most common remedies ; but we seek always 
in our prescriptions to find that remedy which covers the totality of 
symptoms as presented by the patient. Acting upon this plan we feel 
encouraged by the results of the past to keep on with our investiga- 
tions and our experiments in the future ; until we have found better 
and surer means for the cure of the insane. 

As an illustration of the benefits of the rest treatment and suitable 
diet, we present the following case, collated by Dr. Williamson, my 
assistant, from our case books : 

No. 1988 was admitted to the State Homoeopathic Asylum for the 
Insane, December 10, 1886. The patient was a female ; age, 30 ; 
single. She was of a nervous temperament, but had no history of an 
inherited predisposition to insanity. About five years ago this patient 
caught cold while menstruating, and the menses were suppressed. This 
was the supposed cause of the present attack. During the past five 
years this young lady had had repeated attacks of excitement, during 
which she was very violent, and on one occasion had threatened to kill 
a brother. When admitted to the asylum she was pale, weak, and 
anaemic. She weighed ninety-one pounds; her pulse was 88, and 
weak; her temperature was 100.02 ; respiration, 20 ; pupils, dilated ; 
appetite, poor ; bowels, constipated ; menses, regular as to time,but very 
profuse. The patient was, and had been, greatly troubled with 
insomnia, and for two years previous to the asylum she had been able 
to secure sleep only by ether inhalation, or chloroform,or by the use of 
the hvdrate of chloral. 

When admitted, the patient was very much excited, and quite noisy, 
screaming about people applying electricity to her. Afterwards was 
very tearful for several days. 

Considering the cause, the condition, and the mental symptoms 
presented, she received Pulsatilla. The patient was placed in bed, and 
perfect rest enjoined. The diet ordered was hot milk, hot beef tea, 
Mellin's food, and other easily digested nourishment, as the appetite 
of the patient craved, such as broths of various kinds. 

The day following admission the temperature of this patient had 
returned to the normal. This patient remained, without restraint of 
any sort, quietly in bed ; and on the 5th of January, 1887, she men- 
struated without pain, without excessive flow, and without any return 
of the delusions or mental excitement. While menstruating, the only 


64 Bureau of Mental and Nervous Diseases. 

abnormal exhibition was a tendency to weep in a quiet and subdued 

On the fifteenth of January, about five weeks after admission,she was 
allowed to sit up for the first time. The pain in the ovarian and 
uterine regions, which had troubled her for about five years, had 
entirely passed away. Since that time she has been able to walk about, 
both in and out of doors, visiting the green-houses, and strolling around 
the grounds as much as she wished. 

February first, fifty days from the date of her admission, she weighed 
114 pounds, a gain of 23 pounds. This patient now sleeps well, has a 
good appetite, is in good spirits, and her mind is clear and free from 

-/ # 



By Chas. E. Walker, M. D. 


Perhaps no subject in medicine is more vague or misunderstood by 
the profession at large than the symptomatology of nervous affections. 

I do not expect to elucidate the few nervous phenomena that I shall 
speak of to the entire satisfaction of those present, nor even to the 
satisfaction of myself. I seek for more light and write with the hope 
that these random thoughts may open up a mine of experience and 
research from those older and wiser. 

To accurately diagnose a disease of the nervous system the physician 
must study his case carefully and arrive at conclusions slowly. Close 
attention to details and a careful review of the case will often correct a 
hasty diagnosis. The foundation of a correct diagnosis is a thorough 
anatomical knowledge of the whole body, and a clear understanding of 
the function and physiological behavior of the glandular system. A 
deranged stomach, a perverted liver or an overturned uterus will often 
set up a train of symptoms that might be mistaken for some grave 
organic nerve lesion. 

Bureau of Mental and Nervous Diseases. 65 

To understand those diseases aright, demands the wide scope and 
experience of the whole field of medicine as well as special study, both 
in books and in the hospital. In studying the symptomatology of 
nervous diseases, all symptoms may be grouped in two great classes : 
Affections that depend on a destruction of the parts — organic diseases ; 
and those functional derangements that depend upon perverted action 
or mal-nutrition of the nervous organs or elements. Among the grand 
characteristics which distinguish these two great classes of diseases, we 
may notice that in organic lesions the symptoms are permanent and 
uniform, the objective signs predominate, there is a gradual progress 
toward a fatal termination, either with reference to life in general or 
to that of parts or organs. (Lastly, the patient's mind is not occupied 
so strongly with his own feelings and condition as in those diseases of a 
functional type. The functional derangements are characterized by 
indefinite and indescribable feelings. They are as transient and 
flighty as the showers of an April day. One hour the patient thinks 
death is after him and hastily summons his medical adviser, who, 
perhaps, arrives to find his patient feeling as well as usual. The , 
subjective signs always take a prominent place in the history of every 
case of functional nervous disease. Seguin, of New York, says : " The 
Ego is very strongly and deeply affected, fear, depression and constant 
dwelling upon the symptoms being prominent features." 

These are general statements for the preliminary study of a case. 
They are all liable to exceptions and each patient must be separately 
considered. We must individualize our case, and while we, by so 
doing, more quickly arrive at a correct diagnosis, we also are thereby the 
better enabled to select the proper remedy for treatment. 

Right here I wish to enter my protest against the statement often 
made by members of the homoeopathic profession, that a diagnosis is 
not a necessity to the proper treatment of a case. Symptoms are 
all we need — and the indicated remedy. Where is the benefit of 
remedies in a case of numbness of one side, with tingling of the fingers 
and toes, and pressure and pain on top of the head % What would 
Aconite or any other indicated remedy do when the whole train of 
symptoms depended upon a dislocated uterus % What would be the 
indicated remedy when a severe facial and orbital pain depended upon an 
exostosis or a thickening of the periosteum i Let us have as good a 
diagnosis as the science of medicine and patient and painstaking study 
will give us ; then select our remedy according to the totality of the 
symptoms and according to the law of Hahnemann. " Prove all things, 
hold fast that which is good." 

6ti Bureau of Mental and Nervous Diseases. 

It must be borne in mind in studying our cases that what to-day 
appears as a functional derangement chiefly indicated by subjective 
phenomena, may, in a few months, present distinct signs of organic 
changes in the nervous system. Sometimes, even after the most care- 
ful study of our case, we cannot be sure as to the presence or absence 
of organic changes. 

Subjective symptoms are those sensations experienced by the patient 
in the absence of any visible signs to the investigator. A patient 
comes to you and says he has the jumping toothache. There are no 
signs visible to the doctor that the patient has pain. The sensation is 
purely subjective. 

Objective phenomena are those 6igns which the physician can see 
for himself, and knows the value of his observations. A patient is 
seen with a hot skin, which is felt, a bounding pulse, which is counted, 
a high temperature, which is indicated by the column of mercury. 
These are objective symptoms. They require no words from the 
patient to obtain them . 

Of these two classes of signs the objective is far the more valuable. 
On this class of symptoms the patient's imagination or his willingness 
to deceive, can have no effect. 

One of the commonest of subjective symptoms, and a -symptom that 
appeals the strongest to the doctor for relief, is pain. What is pain ? 
•Dunglison says, " It is a disagreeable Rensation that scarcely admits of 
a definition." Stewart, of Edinburgh, says that " pain is the repre- 
sentation in consciousness of certain impressions, or of an excessive 
degree of any kind of sensory impression/' Those sensations that give 
pleasure may by a continuation or in excess become a real pain. 

Pain is always the result of an irritation. This irritation may be in 
the nerve-endings, in the nerves themselves, in the cord or in the sen- 
sory centers. Wherever the source of irritation may be, the pain is 
always referred to the peripheral area of the sensory nerves. 

No manifestation of pain is more common or more troublesome to 
treat at times, than headaches. 

Many forms of headache are symptomatic of some organic lesion 
of the brain, as in tumors and exostoses. Headache is a constant attend- 
ant of fevers. Headache occurs in the weak and thin -blooded person 
from anaemia. Women are the most common sufferers of the anaemic 
headache, and uterine diseases or disorders of menstruation are con- 
nected with it. The pain is of a dull character, usually in the vertex 
or temples. I have so often found a " top-headache " associated with 
uterine trouble that I sometimes call it uterine headache. 

Bureau of Mental and Nervous Diseases. 67 

The sympathetic headache is closely allied to the foregoing in char- 
acter and situation. It is generally connected with disorders of the 
digestive and sexual organs. Many of us have experienced, after a 
twelve or fourteen course banquet, in honor of the founder of our 
school, that pleasant feeling — a morning headache, from gastric dis- 
turbances. The headache of ovarian disease is familiar to all gynaecol- 
ogists. Not only headaches but severe neuralgias in other remote 
parts are known to arise from ovarian irritation. Professor Hay, of 
Aberdeen, once had a patient that had for two years and a half, once a 
month, at the menstrual epoch, an attack of earache so agonizing that 
she screamed aloud and had to be held in bed. During the inter- 
menstrual period she was perfectly well. The thought occurred to 
the professor that the cause might be ovarian irritation. He produced 
firm pressure over the ovaries and an immediate relief followed. I 
have in mind a case in which there was extreme pain in the little 
finger just before the catamenial flow appeared. As soon as the flow 
was fully established, all pain ceased. This was undoubtedly a case of 
reflux pain from an ovarian irritation. 

There is a kind of headache that can be properly considered as sym- 
pathetic, namely, over-straining of the eyes, either from improper 
glasses or no glasses at all. Many persons have suffered for years from 
headaches of this nature, without its being suspected. The fact has 
long been known to oculists that disorders of the refractive apparatus 
of the eye would give rise to cerebral discomfort and pain ; but physi- 
cians in general practice are apt to overlook defects of the eyes to ex- 
plain headaches where the causes are obscure. Weir Mitchell brought 
these facts to prominent notice in 1874 and again in 1876. The points 
made by him were — 1, that many headaches are caused indirectly by 
defects of refraction or accommodation ; 2, that in these instances the 
brain symptom is often the only prominent symptom of the eye 
trouble, so that there may be no ocular pain, but the strain of the eye 
muscles is expressed solely in frontal or occipital headaches ; 3, that 
long continued eye troubles may be the unsuspected cause of insomnia, 
vertigo and nausea ; 4, that in many cases the eye trouble becomes 
suddenly injurious, owing to break-down in general health or to 
increased sensitiveness of the brain from mental or moral causes. 

There are various illusive sensations that form a prominent part in 
the symptomatology of nervous affections. The girdle-pain, or belt 
sensation, is one of these. It is a feeling as if a belt were tightly bound 
around the thorax, abdomen, or other part. 

The sensation does not go straight around the body, but obliquely in 
a line of the distribution of some nerve. In direction it extends froia 




tlie back obliquely downwards and forwards. This symptom corre- 
sponds in location to the altitude of the lesion in the spinal cord. In 
progressive locomotor ataxia, when the lower segments of the cord 
are diseased, the girdle sensation will be found in the hypogastric or 
umbilical regions, as the lesions of the cord progresses upward, the belt 
symptom travels upward, involving the thorax, and even the larynx. 
The girdle pain is a common symptom of myelitis, acute and chronic, 
and in locomotor ataxia. 

Another common subjective symptom is the feeling of heat and cold. 
A patient will say that one foot is intensely hot, while the other is ice- 
cold. An examination of the parts will show the temperature to be natural. 
The sensation of heat may be constant, or in flashes. Sometimes the 
patient will describe a sensation as if a stream of some hot substance was 
passing through the thorax and abdomen. Again, the patient will say 
that something as cold as ice-water is dropping on the heart. A sensa- 
tion of great coldness is more frequently felt in the legs. One of the 
key-notes of the remedy, Sepia, is the feeling of wearing cold, damp 
stockings. All are familiar with the hot flashes of the climacteric 
period. They seem to pass like a hot wave from the feet to the head. 
These symptoms are purely functional and transient in their duration. 
•The origin and cause is not well known at present. 

There are cases in which the objective symptom of rise of tempera- 
ture is out of all due proportion to the feelings of the patient. There 
are cases on record of hysterical hyperpyrexia where the temperature 
has reached 110°, 115° and even 122° F., without any permanent 
mischief following. The only way, says Stewart, of Edinburgh, in his 
" Lectures of the Diseases of the Xervous System," that this astonish- 
ingly high temperature can be accounted for, is, that there must be 
some disturbance in the heat -regulating centre in the cortical layers of 
the brain. 

Another set of subjective sensations are the feelings described as 
numbness, tingling, pins and needles, and formication. These 
symptoms occur from changes in the nerve-endings, or from disease of 
the nerve trunks. Well-marked cases are on record of paralysis of the 
hands and feet as a result of temporary compression of nerve-trunks, 
or from disease of the same. These symptoms are also seen frequently 
in diseases of the cord and of the brain. A deranged stomach, a torpid 
liver, and diseases of the sexual organs will often give rise to this same 
train of symptoms. 

In connection with those symptoms just mentioned, I will speak of 
vertigo. This symptom almost arises to the dignity of a distinct 

Bureau of Mental and Nervous Diseases. 69 

disease. Weir Mitchell, in Pepper's System of Medicine, gives it a 
consideration of about fifteen pages. 

Vertigo is a feeling of uncertainty, a sense of defective equilibrium, 
with or without actual disturbance of position, and accompanied by * 
varying amounts of subjective feelings of motion of external objects, 
of the body itself, or of the contents of the cranium. 

Vertigo may arise from a great variety of causes. It may result 
from external conditions, as in the dizziness of high altitudes. It may 
be the result of certain toxic influences, as alcohol, tobacco, and stram,- 
moniun. It is seen in the dizziness of sea-sickness, swinging, riding 
backwards in a carriage. 

It results from disease of the spinal cord, as can be seen in tabes 
dorsalis, from disease of the cerebellum. AVothnagel says : " The most 
characteristic symptoms of cerebellar disease are inco-ordination, a 
titubating gait, and intense vertigo." 

Vertigo is seen in nearly every organic disease of the nervous system, 
and perhaps still more so in functional disorders. It is a prominent 
symptom in some diseases of the eye, and more so in those of the ear. 
Diseases of the stomach, liver and kidneys have vertigo classed among 
their train of symptoms. Even disease of the larynx in certain forms 
is said to have caused vertigo. Thus we see that that this symptom of 
uncertainty is an ever-present one in numerous affections. Sometimes 
difficult to find its cause, oftener troublesome to remove its effect. 


Dr. G. E. Gorham : I think the time is coming when we shall 
find more organic defects to account for the now so-called functional 
symptoms. Dr. F. N". Otis has shown us that many apparently func- 
tional symptoms, coming and going, will be found to depend on organic 
disease of the urethra. I believe the day will come when we will find 
that the sympathetic nerve excitation at the orifices of the body is a 
cause of many of the nervous symptoms which we now speak of as 
functional conditions. About two years ago I saw a patient who had 
suffered many things of many doctors, but without relief, who was 
entirely cured of his nervous symptoms by slitting up the foreskin. 
Another man suffered with pain in the tuber ischii and knees, had 
become irritable and sleepless, and unable to do any mental or bodily 



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Bureau of Mental and Nervous Diseases. 

work, but was thoroughly cured by passing a sound through the 
prostatic urethra. I believe that the rectum will be found to be one of 
the richest fields for the discovery of these pathological lesions. I am 
glad to hear the doctor make the prophecy he did. 

Dr. T. L. Brown : It will be an interesting point, in these 
nervous conditions, to discover whether the pain is in, say, the finger, or 
in the brain. The course lesions in extremities made by wounds will 
produce the local pain undoubtedly, but it is in the nervous diseases 
themselves that this question can come up. What is pain, — a thought 
or perception, and is it in the brain or in the spot subjectively located? 
We must have some idea if pain is a thought, and there must be some 
substance to produce pain, no matter where it is. The insane patients 
must have something to make them think there is pain. We must 
examine this question carefully, as it is an interesting one. 

v. ' •. 

1 t 




Everitt Hasbrol t ck, M. D., Chairman, 
Drs. Wm. N. Guernsey, 

Phocbe J. Waite, - 

W. W. Blackman, 

Henry Minton, 

George E. Gorham, - 

J. N. Tilden, 

W r . II. Proctor, 

Edwin Fancher, - 

C. A. Groves, .... 
J. W. Candee, - _ . 
Wm. A. Allen, - - - 

S. P. Burdick, - - 

D. B. Stumpf, .... 


New York City. 

New York City. 










Oakland, Cal. 


Disputants: Drs. L. L. Danforth, New York City. 

J. Nicholas Mitchell, Philadelphia, Pa. 


By J. Nicholas Mitchell, M. D., 


In May of this year, I was requested by a friend, a man of large 
experience in obstetrics, to see with him a lady who had been in labor 
for some hours and who seemed, as he said, " to have neither cervix nor 
08." When I reached the house I found that the patient had been in 
labor some eight or nine Iioufs ; that the first symptoms of labor had 
been the discharge of a dark fluid in sufficient quantity to make her 



>X , 72 Bujreau of Obstetrics. 

v?** 1 




Ji'! nurse announce it as " the waters;'' that the pains were coming with 
^.if great regularity and were excessively severe, and that a discharge of a 

dark inoffensive character still continued. Upon vaginal examination, 
$> s the vagina seemed to be a closed cul-de-sac, much shorter than usual ; 

the roof and portion usually occupied by the uterus felt hard and 
$$' resisting, and were not affected by the pains of the woman, and there 
^ was no posterior cul-de-sac^ this space being filled in by this same hard, 

f^< resisting body. Abdominal examination revealed two tumors in the 

?i^, abdomen, each one running obliquely upwards in opposite directions 

from the pelvis, and thus leaving a certain amount of space between 
^ them at their upper extremity. 

k .;v - The tumor running upwards in the left side of the abdomen was 

V$-y found to grow hard under the hand when the pains came on, while 
?>/J.'\ that on the right was unaffected by them. A second vaginal examina- 
tion succeeded in passing two fingers between the symphysis pubis and 
the hard presenting tumor, and with the tips of the fingers the os was 
felt above the brim of the pelvis, partially dilated and to the right side. 
J. Judging then that the tumor in the left side of the abdomen was the 

y uterus with its cervix presenting thus at the right inquinal ring, the 

V axis of the uterus was in such a position that if a straight rod had been 

if-',;' passed through the abdominal wall to the right of the mons veneris 
4 it would have entered the cervix at that place and have passed obliquely 

' upwards across the abdomen to the other side. It was also discovered 
<r.. v that the breech presented, and a diagnosis made of labor obstructed by 
V , ' a tumor, probably ovarian. My first attempt was to push up the 
X : tumor out of the pelvis and push the uterus and child down in its place. 

After long continued effort in this direction without success, I 
determined that one of two things must be done, viz : either tap the 
tumor or perform a laparo-elytrotomy. Before attempting either of 
i. these operations, however, we sent for further counsel. There was an 

interval of time from 9:30 a. m. until 1:30 p. m. before we again met 
with our added counsel. An examination revealed that during this 
time some change had occurred which permitted the hand to be passed 
by continued pressure between the symphysis and the tumor ; our 
counsel advised against either tapping or cutting, and, himself, pulled 
down the breech of the child, and, being tired with his efforts, left 
I me to deliver the head and shoulders, which was done without any 

great effort. The woman rallied very well from the operation and 
ether, but had no contractions following the deliverv of the child. The 
y placenta seemed to be entirely adherent since there was no hemorrhage. 

|t During this time of waiting for the placenta, I again made an effort to 


i ?i 



Bureau of Obstetrics. 73 

push up the tumor out of the pelvis, but was still unable to do so. 
After waiting for a while, without contractions ensuing, friction over 
the abdomen and medicines were resorted to, and a severe hemorrhage 
coming on, the hand was passed into the uterus, and the placenta, which 
was found partially adherent, was removed. The woman rallied well 
from the labor, and after putting a few stitches into the torn perineum, 
which needed no ether to perform, I left her some three hours after 
the delivery, with a fairly good pulse, a temperature of 100.5°, with a 
perfect consciousness and recovery from shock, and with a fairly- 
contracted uterus. $ This was at 9 p. m.; at 6 a. m. the following day I 
was called to her, and found her colorless, pulseless, and restless, 
throwing her hands up over her head and gasping for breath, partially 
conscious, and with cold and clammy extremities. The hand placed 
upon the abdomen could discover the tumor in the right side of the 
abdomen, but nt> uterus could be felt. I then discovered that no 
discharge of blood had occurred externally since I had left. The woman 
very shortly died. Unfortunately no post mortem examination was 
allowed, but from the fact that I could feel no tumor, suggesting a 
concealed internal hemorrhage, and that there had been no pains, and 
no discharge externally, and knowing that she had rallied from the 
shock of the delivery before I had left her on the evening before, I 
concluded that there must have been a rupture of the uterus, and that 
the constant flow of blood through this rupture had produced her 

I thought that she had rallied too completely from the shock for 
that to be looked upon as the cause of death, and felt that if the tumor 
had ruptured we should have had symptoms from the beginning, and 
no rallying from the shock. AVhereas, I supposed that possibly the 
laceration at first might not have extended through the peritoneum, or 
might have been closed by the first contraction. 

As an interesting fact it may be stated that I learned some weeks 
afterwards that she was the third in her family who died from ovarian 
tumors complicating labor. 

Remarks. All authors agree that a tumor complicating labor and 
obstructing the pelvis is of most serious import to both mother and 
child. Anyone who has had to contend with such a case has the sub- 
ject brought to his attention in such a way as to impress this fact upon 
him more than any words or writing can possibly do. This makes the 
third case in my experience. In both the others it was possible to 
push the tumors up out of the way. One case then needing version 
by the feet to effect delivery ; the other, after the tumor was pushed 

$1 • • 



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N V 


'74- Bureau of Obstetrics. 

up, was delivered naturally. In both cases mothers and children 
^ ' were saved. 

Hodge notes as quoted from Cayeaux Puchell's statistics as follows: 
Out of thirty-one cases, fifteen women and twenty-three children per* 
ished. One woman and twenty-one children died during labor. In 
five cases where no assistance was offered, four women and three 
children died. In one case, the child and mother were saved by push- 
ing up the tumor ; in a second case the child died but the mother sur- 
vived. Version was performed twice — after pushing up the tumor — 
both children and one mother perished. Puncture of the tumor was 
made in three cases ; one woman escaped, two women and three chil- 
dren died. Incision of the mass was performed in four cases ; three of 
the mothers and one child survived ; one mother and three children 
were lost. In one case, where the forceps was applied, the mother and 
. child perished. Craniotomy was performed six times, three of the 
mothers only recovering. The blunt hook was used in some cases, 
with safety to both parties. Dr. Merriman reports eighteen cases : 
Of these, nine mothers died, three recovered imperfectly and six 
completely. Dr. Litzmann reports fifty-six cases ; twenty-four mothers 
died and thirty-two recovered ; of the children seven were born alive, 
thirty-five were still born and of the remainder no account wa6 given. 

Playfair tabulates fifty-seven cases. In thirteen, labor was termin- 
ated by the natural powers alone, but of these, six mothers, or nearly 
half, died. In favorable contrast with these we have the cases in 
which the size of the tumor was diminished by puncture. These are 
nine in number, in all of which the mothers recovered, five out of the 
six children being saved. The reason of the great mortality in the 
former cases is apparently the bruising to which the tumor, even when 
6mall enough to allow the child to be squeezed past it, is necessarily 
subjected. This is extremely apt to set up a fatal form of diffuse 
inflammation, the risk of which was long ago pointed out by Ashwell, 
who draws a comparison between cases in which 6uch tumors have 
been subjected to contusion and cases of strangulated hernia ; and th& 
cause of death in both is doubtless very similar. This danger is 
avoided when the tumor is punctured, so as to become flattened 
between the head and the pelvic walls. On this account I think it 
should be laid down as a rule that puncture should be performed in all 
cases of ovarian tumor engaged in front of the presenting part, even 
when it is of so small a size as not to preclude the possibility of deliv- 
ery by the natural powers. 

Barnes gives the following summary of Rules of Management of 

Hor complicated with Tumors: " 1. Push the tumor above and 

Bureau of Obstetrics. v 75 

aside if possible. 2. If the tumor be fluid and it be thought better 
not to attempt its removal, tap it by aspirator-trocar. 3. If solid, 
puncture by aspirator-trocar, and if still undiminished in bulk, 
remove it if possible. 4. If the tumor cannot be acted upon advanta- 
geously, reduce the bulk of the child. Turn, perforate, crush the head 
by cephalotribe, reduce by lamination. 5. If neither tumor nor child 
can be advantageously acted upon per vaginam, resort to the Caesarian 

"As in our case nothing but an attempt to push up the tumor was 
made and none of the other rules laid down above — though puncture 
or laparo-elytrotomy, if that failed, was suggested by me, but overruled 
at the consultation. It may be proper to say that labor had been going on 
for so long a time before our consultant arrived that he thought that 
the risk of infection was greater than the likelihood of damage by 
compression, since so much more space presented for delivery by this 
time than was found earlier in the labor. 

The delivery of the child was remarkably easy considering how small 
the space had seemed at first, but from the oblique position of the 
uterus above the pelvis and lying across the tumor, the pressure of 
bringing the child into the axis of the pelvis was brought to bear upon 
the posterior wall of the uterus, by having to pull at right angles to 
the axis of the uterus, and across the tumor like a lever below, and I 
fear that the strain was too great and resulted in a laceration of the 
posterior wall of the cervix and that this laceration extended into the 

From my experience in this case I have determined that even when 
there seems, as there did in this case finally, to be room enough to give 
passage to the child, that if attempts to push up the tumor fail, either 
puncture should be tried, or in case of failure to empty the sack, oper- 
ation for removal of the child either by craniotomy or through the 
abdominal walls by some one of the different operations, should be 
attempted. In this case, from the position of the uterus, Thomas' 
operation of laparo-elytrotomy suggested itself to me. Statistics of 
craniotomy in these cases show very conclusively that the mortality is 
as great as in Porro's operation under ordinary circumstances, so that I 
should feel inclined to give the child the benefit of this latter opera- 
tion, or, if practicable, of Thomas'. 


Bureau of Obstetrics. 

Obstetrical Memoranda and experiences. 

By E. Hasbrouck, M. D., 


My practice began in March, 1805, and from that time until April 
12th, 1869, was entirely within a farming district, where were 
attended, probably, h'fty cases of obstetrics. My first case in Brooklyn 
occurred April 23d, 1869. From that date until December 31st, 1886, 
nine hundred and fifty-nine (959) cases have fallen into my hands. 
The deliveries of thirty of these were attended for me by profes- 
sional friends. Including premature births occurring after the sixth 
month of gestation, the 959 cases yielded 971 children, of which 488 
were males and 483 w T ere females. 

The nativity of the parents is covered by the following table : 

United States, 




Scotland, - 




Norway, - 




The cases were distributed through the months of the years as 
follows : During 







West India Isles, 



- 88 






















- 11 






















Prince Edward's 














- 84. 

- 85. 

May, - 

- 62. 

- 84. 

July, - - 103. 
August, - 76. 

September, - 71. 




- 110. 


- 90. 

The largest number of cases in one month was thirteen. These 
occurred during October, 1881. Twelve cases occurred during July, 
1875. Eleven occurred in each of three other months. A record of 
796 of the 959 cases presents the following as the hours during which 
the births occurred : From 

12 to 1 

ji • aXI • i 


8 to 9 a. m., 


4 to 5 

P. M., 


1 to 2 



9 to 10 " 


5 to 6 



2 to 3 



10 to 11 " 


6 to 7 



3 to 4 



11 to 12 " 


7 to 8 



4 to 5 



12 to 1 P. M., 


8 to 9 



5 to 6 



1 to 2 " 


9 to 10 



6 to 7 



2 to 3 " 


10 to 11 



7 to 8 



3 to 4 " 


11 to 12 



Ik'KEAU of Obstetrics. 77 

Tliese compilations were originally made during the summer of 
1885. At that time the record presented the fact that the greatest 
number of births had occurred between 7 and 8 a. m., and the smallest 
number between 2 and 3 p. m. It will be observed that the record has 
been extended for one vear and eight months, and that these hours are 
yet credited with the largest and smallest number of births. The 
records show that twenty-four of the children were still-born. The 
true or supposed causes of death is not fully recorded, therefore no 
attempt is made to classify or enumerate. 

One child had complete imperforate anus, a defect which was not 
discovered for more than twenty-four hours, when by lamp-light 1 
made an unsuccessful operation for its relief, the child dying before 
morning. Another child had an imperforate anus, for which nature 
undertook to compensate by placing an outlet (about the size of a goose 
quill) for the intestinal tract, within the vagina. This case was oper- 
ated upon with only partial success. The child dying after several 
weeks from inanition. Three other cases of malformations occurred, 
"the particulars of which present features of interest. See Transac- 
tions of this Society, Vol. XV., pp. 173 and 174. 

Prolapse of funis is recorded seven times. One of the women 
informed me that this complication had existed with her in three suc- 
cessive labors. I have no recollection of having delivered a living 
child when complete prolapse of cord was present. Seven versionsare 
recorded, but I am certain that this number does not represent all the 
cases in which I have performed the operation. Presentation of 
shoulder or hand usually demanded the procedure. 

Forceps were used twenty-three times with my own cases, and few 
times in cases of other physicians. Prolonged labor from inefficient 
pains w r as the usual incentive for forceps delivery. The Comstock 
(St. Louis) forceps is the only kind used, no difficulty having been 
experienced in application or use, except in one instance as will be 
related later. Eleven breech presentations are recorded. A larger 
number probably occurred. Memory leads me to say that probably a 
majority of the cases resulted in the birth of living children. My first 
" twin " case was met seven years after beginning practice. Twelve 
are recorded, none of which presented features of special interest. In 
one case there were two amniotic sacs, two placentas and two cords, but 
usually one placenta with two cords were found. Puerperal 
convulsions occurred five times. Seven mothers have died, viz : Two 
from convulsions, two from metritis, one from probable rupture of the 
uterus, one from pneumonia eighteen hours after delivery, the disease 

Bureau of Obstetrics. 

ent before the onset of labor. One who was excessively 
jiid had had several light convulsions before, and two after 
, was given Hyos, which seemed to prevent a recurrence, 
proceeding satisfactorily, the forceps were applied, but failing 
eliver, the aid of our colleague Dr. Henry Minton was 
He first applied the Comstock forceps, and being unsuc- 

delivering, applied those of another pattern. After 
le and sufficient effort had been made with these we saw no 

than craniotomy, which operation was skillfully performed 
tor, and then, as the child was exceedingly large, it was not 
mplete the delivery. The patient died during the second 
auses of death being uraemia and shock. Placenta previa 
our times, of which one was a central importation. Partial 
i occurred twice successively with the 3ame patient. In no 
as premature labor induced. The mothers recovered, all the 
jeing still-born. Many cases of post- par turn hemorrhage 

met, but fortunately, none proved fatal, all being easily 
by the usual remedies and manipulation. The most severe 

two of the internal variety. A curious case was one of 
dry labor, during which not ten drops of fluid of any kind 
larged. Of the truth of the assertion I am positive, as I was 
ng before the membranes were broken. The child was the 

ever handled by me, and" leads to the query — Is there a 
jtween absence of amniotic fluid and fietal adipose develop- 
*ne patient had mania after two successive pregnancies. Both 
:re mild. The first soon subsided. The second continued 
eight weeks. The woman has not since been pregnant, and 
I in the enjoyment of fair health. With the presentation of 
>ing there is a consciousness that it is without practical value, 
y of passing interest as relating some of the obstetrical 
is of one individual. It may be permissible to make the 
that the number of cases reported will probably compare 
with the number which lias occurred in the practice of any 
najority of practitioners during the same length of time, and 
t seems to have been a practice remarkably void of severe 

[ am unable to report, as has been done by some obstetri- 
: " no parturient has died," yet, judging from observations 
practice of my immediate professional neighbors, and the 
3 possessed of the character of the fatal cases, the list of 
lot viewed with feelings of complete dejection. 

Bureau of Obstetrics. 79 

An attempt was made to add other points of interest by stating the 
number of primipara and multipara — together with the ages of 
mothers, oldest and youngest, and relative, but it was found that the 
demands of the Health Board of our city for such memoranda were so 
recent as to make the available material uninteresting. 

Having trespassed upon your time and patience with non-practical 
matter, permit the presentation, in an order not justified by text-books, 
of some features of practical obstetrics. 

It has been stated that my obstetrical practice is personally considered 
remarkably void of complications. In making this statement, the 
reference related mainly to events connected with the deliveries. It is 
now added that diseases such as metritis, metro-peritonitis, cellulitis, 
and septicaemia, etc., which sometimes attack the parturient woman, 
have been so infrequent as to have led to the inference that, perhaps, 
such results could safely be, principally, ascribed to the almost invari- 
able use of Arnica. 

Unless some other drug is plainly indicated, every parturient in my 
care receives Arnica, first to sixth dilution, immediately after (and 
sometimes before) the completion of labor. It is given, a dose every 
hour during the first few hours, and continued at gradually lengthened 
intervals, until my visit on the second day. Then Bryonia, 12 to 30, is 
substituted, and continued until the lacteal secretion is established, and 
the breasts in a normal condition. If by this time the bowels have not 
been relieved, and there is no special urgency in that direction, then 
Kux. vom., 12 to 30, is given, until that event occurs. It is acknowl- 
edged that this method is routine practice, and not commendable for 
its scientific quality, being only justified by a satisfaction which prob- 
ably compares favorably with that secured by other methods. The fact 
is emphasized that at all times in the treatment of these cases other 
remedies have been given instead, as they were indicated. 


Without desire to depreciate the value of correct anatomical knowl- 
edge, and the instruction imparted by those whose function it is to 
teach in colleges, or to instill a careless habit into the practice of any 
colleague, I am led to inquire — what proportion of cephalic presenta- 
tions are accurately diagnosed previous to the completion of the first 
stage of labor i Personal experience compels the reply that the per- 
centage is very small. To become accurate diagnosticians of presenta- 
tions requires a cultivation of the sense of touch, and a keenness of 
perception which is, perhaps, rarely reached by the average general 
practitioner. Those of us who may not be endowed with such qualifi- 

^•" 80 Bureau of Obstetrics. 

.■y, cations soon learn tliat in cases without dystocia from deformed, or 
p~ ' abnormally small pelves, the attempt to closely define the presentation 
partakes more of a theoretical than a practical practice of obstetrical 
art. It may also be added in this connection, that to diagnose between 
'• . - cephalic and breech presentations, before the membranes are ruptured, 
is not always as easily accomplished as we may have been taught or led 
to infer. 


Professors and text-books have instructed that the ligature should not 
be applied to a funis until pulsation shall have ceased. In early practice 
jfv this teaching was rigidly adhered to, but as experience broadened, and 

increased demands upon my time came, the rule was frequently 
encroached upon, until now, perhaps not more than once in fifty times 
has pulsation ceased before the funis receives its ligatures. It is some- 
what difficult to correctly formulate an opinion as to the results of such 
practice, but it is believed that no harm has arisen from it. The babies 
have not been unusually subject to colic, nor has jaundice always 
occurred, or have those cases of it which have been seen been particu- 
larly severe and intractable. My custom is to apply two ligatures and 
cut between them, although in some instances when the funis has been 
of unusual length a single ligature was applied, the funis severed, and 
a knot quickly tied on the placental end. The knot or ligature then, 
except for cleanliness, is deemed to be of doubtful utility, believing 
that to allow the placental blood-vessels to become empty will facilitate 
the withdrawal of the placenta from the uterine cavity. Playfair differs 
from this conclusion, and says that the second ligature " is, perhaps, of 
some use by retaining the blood, and thus increasing the size of the 
placenta, and favoring' its more ready expulsion by the uterine 
contraction." In a few instances the funis has been severed without 
previous ligation. In my judgment this practice has no special value as 
a rule, and the undesirable soiling of the bed-linen is, at least, a feature 
which provokes condemnation. The quantity of blood lost by this 
method is comparatively small, a fluid ounce, probably, being a large 


Some books teach the use of, and many women are very particular 
to secure a piece of " bobbin " for ligatures. As it may be twisted into 
a cord, it is not entirely ^unsuitable. Twisted silk having too great a 
degree of softness and smoothness, is much inferior. Twisted cotton or 
linen thread is superior, but from the general character of material, 
and ease of obtainment, nothing more completely fills all requirements 
than a plain piece of the ordinary cotton twine of the stores. 


Bureau of Obstetrics. 81 

dressing of the funis. 

The usual dressing has been a wrapping of old soft linen or muslin, 
without scorching or the application of an oleaginous substance. In 
some instances a square of white cotton wadding or batting has been 
used, but no special value in the article itself has been recognized, yet 
were it always obtainable it would be used, as its application is more 
readily made, and exhibits a more business-like appearance. 


Several instances of knotted funis have been met, and upon one 
were two knots. The probable explanation of such knots is an unusual 
length of the funis and a possible abnormal activity of the foetus. 
Nothing especially practical has been learned from these cases, yet it 
is worthy of remembrance that death of the foetus may possibly occni 
from interruption of the circulation of blood through the funis by the 
presence of a knot. 


We may in thought naturally follow the funis to its source and enter 
upon a consideration of some topics connected with the placenta. In 
my practice its retention from adhesion to the uterine wall has been a 
rarity. Only one undoubted case can be recalled, this occurring during 
my second year of practice. It is proverbial that this complication of 
parturition, as also hour-glass contraction of the uterus, is most fre- 
quently met with by students and recent graduates. The latter embar- 
rassment was escaped in my early professional days, and has remained 
undetected as opportunities and experience have become extended. 


My custom is to place one hand upon the abdomen of the parturient 
and await uterine contraction before attempting to extract the placenta. 
Should the contractions prove feeble and inefficient the hand above is 
used to steady the uterus while the other follows the funis up to the 
os, or if needful, into the uterine cavity. No great degree of traction 
is made on the cord in order to dislodge the placenta, preferring, if it 
is not readily brought forward, and is engaged in the os, to press a 
finger into the suostance, and by a rotary movement effect its with- 
drawal. If the placenta cannot be thus easily removed and is lodged 
higher up within the cavity, then the hand is gently passed through 
the os, and grasping the placenta is carefully removed again. We 
have been instructed to avoid entering the uterine cavity, and without 
doubt such instruction embodies a degree of wisdom. Yet the pro- 
cedure just mentioned has been practiced many times, having yet to 

Bubbau av Obstktbics. 

gnize results which have led to the conclusion that the 
>ecially hazardous. There can he no donbt but that in 
tances where the hand has thus been introduced, a pro 
ture of time and patience on the part of both patient 
would have secured the placenta without such proeed- 
livery the placenta is usually examined to learn if it be 
iou which is generally found to exist. Of course, there 
s when small pieces were missing, then these were care- 
r and removed when possible. 

ler a moment and say that it Is surprising how much 
aratively minute piece of retained placenta will some- 
in a case at full term, or of premature labor after 
month. It is a matter of personal experience at least, 
these classes, retention of portions of the placenta tend 
nsive lochia and septicaemia, while in those of premature 
ing from the third to sixth months of gestation, the dan- 
■e in the direction of hemorrhage, and very slightly 


to be now a much less persistent demand by parturient 
iss, than formerly, for the application of the obstetrical 
i general demand on their part having for its basis the 
if form." This basis I believe to be purely hypothetical, 
unities have been embraced to interview women bur- 
so-called " large stomachs," and learned by the confes- 
■f those that the bandage had received careful applica- 
ir lying-in periods. The conclusion arrived at is, that 
not an active factor in obviating rotundity, and that if it 
age case of midwifery a practical feature, it is the sap- 
re ret retched abdominal parieties during the first few 
very. Exceptionable cases will require the bandage for 
antial reasons. The application of the bandage should 
aoned until firm contraction of the uterus has taken 
adage is omitted in every case where a willing consent 
an be obtained, and of those with whom its use has been 
iave demanded it at a subsequent labor. For those who 
se a straight piece of thin unbleached muslin is applied, 
which, according to thickness, is laid on the abdomen one 
oft napkins, which give firm and gentle protection over 
i insertion, as well as contributes to make the bandage 
s abdomen. 

Bureau op Obstetric®. 83 

breech presentations. 

It is a recognized fact that breecli presentations involve a greater 
degree of danger to the foetus than do those of the ordinary cephalic 
varieties. College instruction and early practice was to allow a labor 
with breech presentation to proceed to delivery without interference 
until the head was about to be born, then as dextrously and quickly as 
possible complete the birth. A few years since a paper was written 
and published by Dr. J. E. Clark, of Brooklyn, since which time the 
suggestions given by him have been followed as closely as possible. 
These are, to change, if possible before the completion of the first 
stage of labor, all cases of breech into foot presentations. He divides 
the cases into two classes : 

1st, and most frequent, is a position where the legs are flexed upon 
the thighs, which brings the feet very near the os uteri. 

2nd. The legs are extended, carrying the feet near the fundus of 
the uterus, by the side of the head. Cases of the latter class being 
those which usually give trouble if left unchanged. Dr. Clark has 
formulated the following rules of procedure : 

1st. In introducing the hand into the uterus, use great gentleness 
with firmness, and always support the fundus with the unoccupied hand. 

2nd. Introduce the hand, the palmar surface of which will pass 
readily along the posterior aspect of the thigh of the foetus. 

3rd. Choose the foot most anterior. 

4th. Never bring down but one foot, reasons obvious. It leaves 
protection for cord and gives bulk for dilatation. 

5th. Do not hasten the passage of the hips through the pelvis. 
Secure all the dilatation possible. 

6th. Guide the rotation of the child in its descent so that the abdo- 
men is posterior in relation to the mother. 

The method of Dr. Clark is commendable because it allows a fair 
control of the delivery, permitting it to be hastened whenever desirable. 


Minute directions for the treatment of the perineum during labor 
are to be found in many of the obstetrical text-books. No attempt 
will be made to traverse the whole subject, allusions being made to 
only two portions of it. The completion of labor is sometimes 
delayed by thick and rigid perinei. In some instances this condition 
has been overcome by bountiful applications of lard or vaseline thor- 
oughly rubbed into both surfaces. In other instances similar inunc- 
tions in connection with the application of cloths, which were wrung 
out of very hot water, and frequently changed, havejsucceeded admir- 

Bureau of Obstetrics. 

ard to the so-called "support of the perineum," the 
ery strongly fixed that the earlier teaching on this sub- 
16, and that that procedure which is termed " support- 
mi " renders no support at all. The usual directions are 
>f the hand is to be covered with a folded napkin, and 

with this upon the perineum at the time the strong 
s of the uterus are forcing the head of the child against 
The .use of the napkin is considered to be superfluous 

as with it the necessary manipulation cannot so readily 
I, moreover, place it on the hand as you may, it is quite 
ie dislodged, and to slip up and cover the thin perineal 
prevent a proper observation by tonch of the distended 
believed that the perineum can be protected from latter- 
re applied directly to its surface, then the bare hand is 
Ie, and of the utility of even this, much honest doubt 

the perineum has, by reason of the pressure of the 
:come so thin and tense as to make laceration appear 
jrent impulse and watchfulness will lead the attendant 
as much of the effects of the pressure as may be possi- 

ci re nm stances. My experience has not taught any 
ch this result is as readily secured as to place the hand 
perineal edge against the head of the child, milking 
e of resistance chosen to be exercised, and thus in a 
ng the impingement of the head from the perineum to 

regulating the force of its propulsion. At the same 
t is instructed to suspend making voluntary expulsive 
Jie practice of this method, serious lacerations of the 
not occurred. It is, however, believed that slight lacer- 
ir under any form of treatment and remain undetected 
. are examined visually instead of digitally. 

forceps the practice has been to encieavor to remove 
sossihle instance before the complete birth of the head, 
inch procedure presents greater possibility of prevent- 
>f the perineum. In a few instances the head has been 
wn on the perineum, the forceps removed and head 
lit perineal damage, only to see it seriously torn when 
ame through. It is certain the worst cases of laceration 
those brought about by the delivery of the shoulders. 


time and paper have been used in setting forth 
to which hand of the obstetrician shall be used in the 


Bureau of Obstetrics. 85 

performance of this or that obstetrical manipulation Such instructions 
are believed to be fallacious, and have been entirely disregarded. The 
obstetrical operator should alike educate both hands as far as possible, 
and then the use of a particular hand will be entirely governed by the 
position of the woman and such other circumstances as may be 
presented in each instance. 


With regret it must be stated that in every instance the attempts 
made to restore to life newly-born infants, apparently dead, have 
proved unsuccessful. In cases which seemed to offer a reasonable hope 
of resuscitation nearly all the recommended methods have been 
faithfully tried. The two following named methods have not been 
used. First — The Indian method, which has quite a number of 
advocates, who reside mainly in the West. It consists in placing an 
apparently dead infant upon a warm woolen blanket, and removing it 
as far from the bodv of the mother as the unsevered umbilical cord 
will permit. The mother is then requested to take a few deep 
inspirations. It is claimed that with every such inspiration the . child 
will open its mouth, gasp and soon begin to breathe. This practice 
was observed among an Indian tribe by Dr. Meisner, of Chicago, and 
by him introduced to the profession. He claimed that the use of the 
method is simply taking advantage of the physiological fact that in 
utero the child breathes simultaneously with the mother. (?) Several 
physicians have published reports of cases restored by this method. 
Second — That known as the Schultz's method. In which the child is 
held by the shoulders, the thumbs resting upon the thorax, the child's 
head towards the operator and its anterior surface to the front ; it is 
then swung upwards, so that its feet perform a revolution, and lie 
between the head and the operator's body, the trunk being then in a 
state of forced flexion. The original position is then resumed by a 
reverse movement, and the repetition of these movements constitutes 
the method. 


Several cases have been met where death of the fcetus occurred 
previous to the expiration of the full time of gestation. Mothers who 
have sought advice as to the results and necessities of such a circum 
stance have been counseled to wait for the appearance of symptoms of 
septicemic infection, or the uterus set up action to expel the foetus. 
The latter procedure has always occurred, and no septic manifestations 
have been observed. The cases have been managed as labor with a 


t full term would have been. The length of time elapsing 
death and expulsion of the foetus was from two to six 
the patients did well, one passing through the experience 
rice being under my care. 

>f post-partum hemorrhage have been easily controlled by 
ternal and internal manipulation of the uterus, together 
ministration of medicine, the usual prescription being 
Have not resorted to the use of ice or intra-uterine 
very hot water (110°). The subject being without special 
itruction in my experience, would not now be referred to 
3 purpose of re-directing attention to an article recently 
! the profession, which, on account of accessibility, should 
3d in connection with this sometimes formidable compli- 
use of Vinegar for hemorrhage was brought to notice by 
rigg, an English physician, who used it in both hospital 
ractice, and relates the following particulars of one of his 
patient belonged to a family of ' flooders.' Her mother 
sr relatives had flooded to death. As soon as the child was 
.a to flood. I expelled the placenta, and gave a wine- 
legar. The uterus, which was very flaccid, and constantly 
ice contracted firmly under my hand, and did not again 
;h the hemorrhage continued to a moderate extent At 
teen minutes I gave a second dose, about two- thirds of a 
This soon arrested the hemorrhage, and the patient did 
h instances it was given pure, without any water. I used 
is beyond holding the uterus, and feel certain that such 
ilte would not have been obtained with Ergot. The action 
k> rapid that its use is not permissible before the placenta 
yr fear of causing a retention of that body, and making 
fficult." He gives other testimony, and draws an infer- 
tile reports that vinegar is likely to prove to be one of 
il remedies for post-partum hemorrhage. 


ery seldom been used during this obstetrical experience, 
lose, and particularly for the purpose of controlling 

In those cases which have received doses of from one- 
toonful of the fluid extracts, for the purpose of exciting 

pains, its use has generally been found to be followed 
msive lochia than has been present in cases in which the 
used. The administration of a full dose of a fluid extract 

Bureau of Qbstetjmcb. 87 

of Ergot, as is taught and largely practiced by our old school brethren, 
ifl a practice which my experience has shown to be unsound in teaching, 
and uncalled for in execution, and, for worthy reasons, much to be 


It is well known that in these later days it is a prevalent practice with 
accoucher3 to have the vagina washed out daily with some antiseptic 
preparation, the most fashionable remedy being at present a solution 
of the Mercuric chloride. This practice has never, with me, obtained 
to any great extent. No case has been thus treated until a particularly 
offensive lochia has been detected ; then injections of from ten to 
twenty drops of a solution of Carbolic acid to the pint of tepid water 
have been used once or twice daily, as indicated. The practice which 
introduces the daily use of the vaginal injection of any kind with the 
average case of obstetrics, is believed to be wrong in principle, and 
decidedly objectionable to the parturient. 


During labors which are severe and prolonged, the anus will some- 
times be forced down and protruded to a greater or less degree. If, 
after such a labor is completed, the parts are examined and the 
protrusion carefully returned within the sphincter, the comfort of the 
patient will be much enhanced, and a possibility of hemorrhoids greatly 

There are times when either because of the birth of a still-born child, 
or death of the infant soon after birth, it becomes necessary to use 
measures to control an excessive secretion of milk in order to prevent 
mammary inflammation. If the child be still-born, it is better to pre- 
vent the secretion if possible. This may oftentimes be done by giving 
the breasts an absolute rest, no manipulation of any kind except the 
application of pieces of muslin, each the circumference of a breast, 
spread with a proprietary article known as Kierstead's Ointment, and 
giving an internal remedy as indicated. Bryonia has been, with me, 
more frequently used than any other drug. Regarding the ointment, 
I have no other than practical knowledge, having used it for many 
years with an almost unvarying success in cases in which it was desira- 
ble to prevent or overcome an undue secretion of milk. So favorably 
is its use regarded that it is believed that if the application be made 
early no breast will go on to suppuration unless unduly handled. It is 
always essential that the breasts be not allowed to sustain their own 

88 Bureau of Obbtetrios. 

weight, but should be well supported by adhesive straps or other 
baudages. Breast pumps are useful, but not nearly so much so as they 
are used, and unless used with extreme care, are pernicious instruments, 
as undue or uneven pressure made upon the breasts with them may 
produce traumatism. Should the breasts become very full, and by dis- 
tension cause severe pain, the pump may have to be applied. Its use 
should be continued only just enough to relieve the tension, and not 
be applied oftener than once, or twice at most, in twenty-fours. If the 
case be one in which the secretion of milk is already established the 
patient will probably be much better served if two or more weeks is 
taken to disperse it, than if it be done in as many days. It may be 
added that the ointment is as useful an adjuvant at the usual time of 
weaning as in the early stages of lactation. If the milk Bupply shall 
have proved insufficient for the demands of the infant, my custom is to 
instruct the mother to drink as much as she is able of the best milk she 
can obtain. Ale, porter and similar fluids used for this purpose, are 
deemed to be stimulants acting at the expense of other portions of the 
body, and not comparable with milk as a supporter of the strength of 
both mother and infant. Among the various medicines that are recom- 
mended to promote lactation, none have proved as efficacious in my 
hands as Calcarea carb., third centesimal trituration, a single dose, not 
repeated iu less than two days, and not at all if an action from the dose 
already given is discernible. Repetition of the dose has seldom been 

In closing this paper it is proper to state that its imperfections and 
disjointedness are fully recognized. Many other points could have 
been brought forward, possibly witli a degree of profit, and perhaps 
some of the subjects offered might wisely have been omitted. Its pre- 
sentation is for the purpose of arousing a comparison of thought and 


Dr. G. E. Gokman: In connection with the paper of Dr. 
Mitchell's, I would report the following case : A lady was confined in 
the hospital during the past summer, and her death was, at first, 
somewhat of a mystery, since she had had a successful delivery, although 
the labor bad been somewhat protracted. During labor the physician 
in attendance thought there might be a second child in utero. There 
was a lump in the uterus as large as my fist, which felt very much like 

Bureau of Obstetrics. 89 

the head of a child, and as the placenta still remained in the uterus, the 
abdomen was large and added its appearance to the idea of there being 
another child. The delivery of the placenta showed that there was not 
another child. The diagnosis was then made that the case was com- 
plicated with a uterine fibroid. The patient did well for two days and 
then, without any hemorrhage or pronounced chill and with very little 
fever, she passed into a stage of collapse and died. There did not 
seem to be any assignable cause, unless it might be that of 6hock. 
Post mortem examination showed an intra-mural fibroid tumor. 

Dr. H. M. Dayfoot: I have listened with pleasure U* the very 
interesting paper of Dr. Hasbrouck, and especially because many of 
his practices are in accordance with my own. I suppose that no two 
practitioners will go over a paper like this one and coincide with the 
writer in every particular ; it is not to be expected, so that what 1 may 
say in the discussion is only a statement of my own peculiar treatment 
and not a criticism of the paper. 

It has been almost a routine practice with me to give Arnica after the 
birth of a child, unless symptoms called for some other drug. I give 
the first or second decimal attenuation. I am very apt to follow this 
with Bryonia. 

In regard to ligation, it is my rule to wait until pulsation has ceased 
before I tie the cord, with this exception, that if the child is still-born 
I sever the cord at once. 

My experience in regard to resuscitating still-born children has been 
more pleasant than the writer of the paper. I think I know several 
children now alive who were, at birth, to all intents and purposes dead. 
By immersing the body first in hot and then in cold water, together 
with manipulation and artificial respiration, I have generally succeeded 
in producing respiration. 

I have had several cases of adherent placenta, perhaps half a dozen 
altogether, one of them being associated with hour glass contraction. 
My practice has been to introduce the hand and separate the placenta. 
I have been successful thus far, having had no other unfavorable result 
than a tedious convalescence. 

It is my practice after delivery to use the vaginal douche. I use it 
at this time in every case, but not afterwards unless the symptoms 
demand it. If the temperature rises to 101, or over, on the second or 
third day, I use the douche, and in the majority of cases it will reduce 
the temperature and abort the inflammation or threatened septicaemia. 
If the temperature rises still higher I do not hesitate to wash out the 
TUerus. In regard to supporting the perineum I agree with the writer 

Bukeau of (Obstetrics. 

liead of the child which needs to be supported and not the 
When labor is too rapid, I make pressure upon the head to 
acerations will occur sometimes, no matter what expedient* 

^er bad a ease of abscess of the breast. On the slightest 
: the patient concerning the breast, I immediately apply 
ie shape of a well fitting bandage. The remedy I use most 
iternally is that recommended by Dr. Lozier, some years 
y the Iodide of Potassium. 

bandage after labor, because I think the patients feel and 
and there ie no valid objection to its use. In regard to 
lave found benefit from five drop doses of Castor oil, three 
I do not make half as many examinations as I did in the 
of my practice, but use anesthetics and forceps more 

. Goeham : A few words in regard to lactation. I had 
describe for a nursing mother on account of inal-nutrition, 
her to use Mai tine. A few days later she reported that Bhe 
ke it on account of the increased flow of milk, which was 
ie child could take, causing pain in the breast. Since that 

used this preparation with good results in cases where 
want of proper supply of milk. I give a tablespoonful at 

I have not seen a case where it has not increased the 
the milk ; of its quality I cannot say, except that the child 
ished by it. 

meting of the medical society held in this city last week I 
isure 6f listening to a paper by Prof. Fordyce Barker, in 
ted that he had tested the use of vaginal douches for three 
g at the same time careful comparisons of the temperatures- 
ras that the temperature was found to be higher when the 
re used than when they were not. He had therefore 
heir use in all ordinary cases after labor. 

. Waldo : I have seen one case of prolapse of the funis 
hild was delivered alive. All attempts to replace the cord 
ailing. The child breathed without difficulty, and required 

swhat surprised at the small number of cases in which the 
pplied the forceps, only twenty three times, I believe. It 
they could have been applied with advantage in a larger 
sases. In 393 cases I have applied the forceps 55 times. 


Bureau of Obstetrics. 01 

I do not know that they have ever done any harm, on the contrary I feel 
that they have saved the mothers many hours of pain. In a few cases 
I thought their early application had saved the children from being 
still-born. The use of the forceps is often delayed too long. If care- 
fully and skillfully applied, and no undue force is used, they can do no 
harm to mother or child. 

In regard to the use of Arnica, I gave it in the first years of my prac- 
tice, bnt I do not use it now, unless it is especially called for, and I can- 
not see but that the cases get along quite as well. I sometimes give a 
few drops of Ergot in a glass of water, as much for the moral effect as 
anything else. At times Gelsemium is used for after-pains. For the 
constipation which is apt to exist in the first few days, I give Is ux 
vomica and employ enemata. 

In one case of prolapsed funis, rigor mortis was fully developed 
when the child was born, the limbs being rigid. In two previous deliv- 
eries of this same mother there had been prolapse of the cord. I 
have not been able to find any record of a similar case of rigor mortis 
developed at birth. In regard to resuscitation of the child, I remem- 
ber two instances where I was called in counsel, in one instance to apply 
forceps, and in the other to turn. The children were restored by the 
vigorous efforts of the attending physician. One child lived twenty-four 
hours, and the other is still alive, now two years of age. He placed a 
handkerchief over the mouth of the child, and while raising its arms 
breathed vigorously into its lungs. After repeating these efforts until 
some life was manifest, a few drops of brandy, and afterwards Nitrite of 
Ainyl were placed upon the handkerchief, and these seemed to aid very 
much. Alternate warm and cold baths were used, and very brisk fric- 
tion was made to the spine with. brandy. Efforts were continued for 
three-quarters of an hour before respiration was fully established, there 
being only occasional breathing up to that time. 

I have seen but few cases of post-partum hemorrhage. I think that 
this is due to the fact that I carefully watch the uterus, and if I find it 
rising up in the abdominal cavity, I keep up vigorous friction over it 
until I feel it contract under my hand. I continue this, sometimes for 
an hour, giving it no opportunity to dilate. I also examine and clear 
away any clots which may have accumulated. In a few instances I 
have introduced the hand and made brisk friction on the inner surface 
of the uterus. I am especially watchful for flooding where the pulse 
is at or above 100 per minute and irregular in rhythm. 

In regard to antiseptic injections I have not prescribed them myself 
but some of the nurses in charge of my patients have made occasional 







92 Bureau of Obstetrics. 

use of them. I have not seen any special results from them, but from 
my reading and the experience of my neighbors, I have come to regard 
them with disfavor. I had two deaths in the 393 cases ; one from 
post-partum hemorrhage with collapse, and the other from convulsions 
caused by albuminuria. 

,Dr. J. L. Moffat: In regard to the care of the perineum, I reraem. 
her one case where the external orifice of the vagina was small, the 
patient having been in labor for a long time, and where the head had 
been pressing on the perineum for one or more hours. Fearing that a 
rupture would occur, and reasoning that a cut surface would heal 
quicker than a torn one, I applied a few drops of Cocaine to the parts, 
and made a cut into it with a bistoury. The delivery was immediately 
effected, and I then adapted the cut edges with serrefines, the wound 
healing promptly. I think this might be a legitimate procedure in 
some cases. I have found free lubrication with oil between the head 
and perineum to be of benefit in some cases. 

My routine practice is Arnica, unless the patient's nerves are 
unstrung. I then give Chamomilla. 

In regard to the use of the bandage, I think it gives comfort, when 
you have a reliable nurse to put it on, but otherwise I get along with- 
out it. I refer to the changing or readjustment of the bandage ; its 
first application I superintend myself. 

Dr. T. L. Brown : I have made it a rule in my practice not to 
• attend a case of midwifery unless I have had an opportunity for 
preparatory treatment. I want to direct their daily hygienic and 
dietetic course. For the plainer they live, the more regular the exer- 
cise, together with thp avoidance of all stimulating food and drink, the 
better will they go through their labor. I use very little medicine in 
these cases. You will seldom have laceration of the cervix, or other 
troubles, when the patient has been previously prepared. If you let 
them do as they please, you have a predisposing cause for innumerable 
troubles always threatening. In an obstetric practice of fair propor- 
tion I have not seen a bad case, and never had but one laceration. As 
a lubricant I use lard instead of oil. I use it freely between the pains, 
letting it run into the vagina as the head recedes, so that with each 
pain the parts are thoroughly anointed. If the pains are regular, as they 
should be in a normal labor, you will not have any laceration unless 
the child's head is very large. We are not as good physicians if we 
depend on the use of Arnica or Bryonia, under certain conditions, as 
we would be if we tried to prevent the- occurrence of these conditions, 
^here is a great difference between a physician and a doctor. I have 

Bubeau of Obstetrics. 93 

practiced midwifery in this way, not for the sake of homoeopathy, but 
for the sake of being a physician ; homoeopathy will take care of itself, 
but obstetrics will not. Take care of your patients day after day ; do 
not take haphazard cases and have bad results. You can all do this if 
you are firm in the matter, and let your patients know that you will 
not attend them unless they give yon an opportunity to put them in 
the best condition you can. They will soon see the benefits of it, and 
will be glad to come to you. I have attended five cases this month, 
and all did well. The physician for his own comfort, if not for the 
patient, ought to be willing to instruct his patients in this matter. Is 
it not better to have everything in readiness beforehand, than to run 
the chances of trouble at the time of, or after labor? See how careful 
the surgeon is in his minutest preparation of his patient, and why 
should we not be as particular in midwifery ? I know whereof I 
speak, and the man who will follow out this practice, will have a much 
more comfortable time than will his neighbor, who does not do so. 
The man who does not care to do this, should not practice medicine. 
I have used the Phosphate of Potassium, 3d to 6th decimal, for an 
offensive odor of the lochia, and in a few hours it would disappear. I 
am not prepared to say that the remedy always made the cure, but in 
other instances where the remedy was not used, the offensiveness 
remained a much longer time. 

Dr. Louis Faust : This is all very well in theory, but what are 
we going to do when we are called to these cases ? Shall we say we 
are not going to attend you because you did not give us an opportunity 
to properly prepare you for the labor. Many times your regular 
patrons do not inform you of the matter until labor is close at hand. 
I would like to do just as Dr. Brown says, would like to have patients 
call on me beforehand, would like to direct their daily care, but it is 
not practicable. 

As to cases of suspended animation, I have had quite a little experi- 
ence in that emergency. Out of 700 to 800 cases of labor, I have had 
six or seven cases of suspended animation, in only one of which was I 
unsuccessful in restoring respiration. My method is somewhat similar 
to that mentioned by Dr. Waldo, except that having cleansed the 
mouth of the child, I blow directly into it with my own mouth. 
Where there is any threatened trouble with the breast, I apply the 
Iodide of Lead ointment ; one dram of Lead to the ounce of Vase- 
line. In every case it has prevented inflammation. Where there is 
a desire to lessen the flow of milk or suppress it, the Iodide lias also 
proven serviceable. 


5» • > 




jMr Bureau of Obstetrics. 

Br. L. A. Bull: I am surprised that nothing was said in the 
paper about the use of Chloroform. I think its safety as an anaesthetic 
in these eases, has been well proven. In regard to antiseptic washes, I 
would like to ask if anyone has used Thymol. Prof. Carl Braun, of 
Vienna, has used Thymol, in the proportion of 1 to 1,000, and con- 
siders it, in particular, superior to Corrosive sublimate. 

Dr. C. E. Walker : I believe in progressive medicine and pro- 
gressive education ; I believe in the fact that our patients can be 
educated to call upon us ante-partum. I have demonstrated to my 
satisfaction, that a patient's condition can be materially benefitted by 
treatment before parturition, and I thoroughly and heartily endorse 
the statements of Dr. Brown in regard to this matter. 

I use, ante-partum, plenty of Sweet oil, with Actea racemo6a 
internally. I have found as an actual fact, that cases which have 
always had difficult labors of from ten to fourteen or more hours 
duration, have been able, by preparatory treatment, to shorten the hours 
of labor and lessen the severity of the pains. I believe thoroughly in 
this kind of treatment. We can easily educate our patients to 
recognize the benefits to be derived from this treatment, so that they 
will be anxious for it. 


Dr. F. S. Fulton: I would like to say a word in regard to the 
haemostatic action of Vinegar. I was sent for recently, in consultation, 
to see a case where abortion was suspected. The patient was flowing 
freely, anaemic, with face bloodless, and lips as gray as the cheeks. On 
examination, a protruding body was found, but its exact nature could 
not be definitely decided. The vagina was filled with clots. These 
were cleared out with warm water, but the bleeding did not stop. I 
then took a Davidson syringe, filled it with Vinegar and threw it 
against the mass, when the hemorrhage ceased almost at once. The 
next time it was syringed out there was no hemorrhage. Later exam- 
ination showed that the mass was a degenerate fibroid polypus which 
had been forced out by the internal contractions, and was bleeding. A 
foetus of immature growth had been expelled, carrying down the mass 
with it. The action of the Vinegar was very prompt. 

In regard to Ergot I have noticed this point. A case of rigid os 
with flagging pains, which were located mainly in the back, yielded to 
Gelsemium, and wishing to increase the pains, I gave a few drops of 
Ergot. It induced persistent, continuous pains, and also brought back 
the rigid os, which felt like two hard contracted cords, one, just at the 
external os, and the second, about one-quarter of an inch higher. This 

■■' In .agitr . 

Bureau of Obstetrics. 95 

condition yielded to Belladonna, and the child was delivered without 
farther trouble. I concluded that the administration of Ergot in the 
first stage of labor, to hasten pains, was fraught with more harm than 
good to the patient. 

Dr. W. C. Latimer : In the early years of my practice I was 
very much confused as to the treatment necessary to be followed in 
confinement cases, taking the teachers' text books and answers to 
questions asked many of the old physicians about these matters. I 
finally decided to discard what they all said and begin investigations for 
myself. So in the treatment of the cord I began by cutting without 
tying, and found it a nasty piece of business. Then I tried tying 
the cord twice and cutting between. I found that the children did 
not do as well as when not tying the cord. Then I tried tying the 
placental end of the cord, leaving the end attached to the child to bleed 
for a time and then tying it. I found that here the results were aa 
good to the child as when I cut without tying at all, namely, freedom 
from colic and jaundice. On the other hand I found that the placenta 
was. more easily delivered ; it seemed to come away more entire, leaving 
fewer shreds behind it, and with less hemorrhage. 

My next experiments were in relation to dressing the cord I used 
scorched linen, and one thing after another, until I finally use exclu- 
sively, a small square of absorbent cotton. I alwaj's carry it with me, 
and I find that the funis dries up quicker under this dressing than 
any other I have used. 

I believe in educating your patients to seek treatment before con- 
finement, and it can be done. I think ninety per cent, of my patients 
engage my services some time before they expect to be confined. 

The question of the dressing of the babe was also an important 
matter with me. I now use only a Canton flannel slip or gown for the 
early weeks. I dress the cord with the cotton and flannel binder, put 
on a soft napkin, and then the Canton flannel gown ; that is all the 
dressing needed for the first month. This is the instruction I always 
give for the first child, afterwards they are willing to follow it without 
instructions. The child rests much better in this dress, consequently 
the mother rests better, and makes a better recovery. 

I have been fortunate enough not to have much trouble with the 
breasts, but where this has happened I have not had any benefit from 
the use of Kierstead's ointment. The best results in my hands have 
been obtained from the use of one-half to one dram of the tincture 
of Belladonna to an ounce of Vaseline. That has saved many a breast 
for mm. 

Bureau of Obstetrics. 

ed in haste to see a woman who had been confined, the 
saying they conld not get the after-birth. She was a large 
woman. The midwife in attendance had pulled off the 
npting to remove the placenta. The latter was still in the 
of the uterus, an hour-glass contraction being present. I 

remove the placenta, after an hour's hard work; the 
ie a good recovery. This is the only case of hour-glass 
I have met. 

[asbrouck: It is quite probable that an ingredient in 
ointment is the Ext. of Belladonna. 
ilso remark, that in my experience there is no department 

in which people seem so penurious as in that of obstetrics. 

the only time when they ask the physician, " How much 
o cost J" They even try to beat you down. I feel that 
Ices I get (twenty dollars and upwards), which includes the 
it is the poorest paid service I render. In the interests of 

think a law ought to be passed compelling every person 
confined to notify a physician to that effect, at least two 
ore confinement. They should become his patients from 
nd lie should visit them at least once a week. 
. Coburjt : I would like to ask if any of the members 
y unpleasant results from the use of maternal washes, such 
anate of Potash, Carbolic acid, etc. I got into the habit of 

because others did. Things ran along on this line for 
until one of my neighboring physicians, a member of the 
^iad one of his patients die, on the third day after confine- 
i child was taken to his grandparents and I was called to 
en learned the following history : The physician thought 

an nnpleasant odor about the patient and directed that an 
lould be given. A fountain syringe was prepared, and as 
egan to flow, the patient gave an exclamation and a groan, 
id, almost before the tube could be withdrawn from the 

id case was in my own practice. The babe was about five 
lien we began to notice a slight odor to the discharges. I 

as usual at about 11 a. m.; her temperature 99£, and 
seemingly all right ; at 2 p. m., call came — they thought 
ring to die." I found her with distended abdomen, intense 
, quick rapid pulse. I asked the nurse as to the cause, and 
; she had administered an injection of Carbolic acid water. 

that not a bit of the water had returned. I made an 

Bureau of Obstetrics. 97 

examination, and found the os closed. Having a pair of placental 
forceps with me, I, by degrees, introduced these into the womb, until 
there was a gush of water. The thermometer at 6 p. m., that night, 
was 104. After about three weeks of violent inflammation, my 
patient made, what was to me, a very happy recovery. 

It is unnecessary for me to add that I now never allow these washes 
after confinement. 

I have made use of several remedies, such as Maltine, Calcarea, 
Bromo and others, for the purpose of increasing the flow of milk. I 
have, however, a case where I want to stop the flow of milk, which 
has now been running for four years. I have used all remedies and 
every expedient, both external and internal, but without any result. 
There is no hardness of the breast, no pain, only a feeling of fullness, 
if the milk is not drawn off promptly. I have tried the experiment 
of not drawing the milk, but the pain is soon so intense that we have 
to resort to it.. The milk has to be drawn about once a dav. 

Dr. Hasbrouck : I will try and help Dr. Coburn out with his case. 
The physician who told me of the use of Calcarea, said also that it 
must be used in the 3d centesimal, for if used in the 3d decimal, it 
would decrease the milk. It seems to me there is some dyscrasia 
involved in this case, and that there must be other symptoms to be 
studied in this case, besides the excessive flow of milk. The remedy 
for the totality of the symptoms will probably cure the case. 

PN»- it..-. 


*V 1 









H. L. Waldo, M. D., Chairman, ... - West Troy. 

Drs. George E. Gorham, - Albany. 

R. F. Benson, --.... Troy. 

F. L. Vincent, ._.... Trov. 

S. N. Brayton, - - - - - - Buffalo. 

W. M. Decker, ------ Kingston. 

T. D. Spencer, ------ Rochester. 

W. C. Latimer, - Brooklyn. 

C. F. Millspaugh, - Binghamton. 

F. F. Laird, --..... Utica. 

Disputants : Drs. Geo. E. Gorham, Thos. D. Spencer. 

By H. L. Waldo, M. D., 


In the present state of sanitary and medical knowledge, and before 
such a Society as this, it would seem almost as though an apology 
were due for presenting for consideration such a worn out subject as 
the above, or for presuming to take the time of medical gentlemen in 
discussing a subject which has been so ably and exhaustively handled 
by so many of our profession. 

My only apology is that the laity, almost without exception, and our 
profession, in a great majority of instances, live in utter disregard of 
the facts relating to the contamination of drinking water, and have no 
idea of the importance of a pure water supply. Large cities are 
wholly supplied from a river which not only contains the sewage 
made in the city itself, but contains all the sewage of large cities 
but a few miles distant, and members of our profession can be found 
who are willing to say that no danger is likely to result from the use 




Drinking Water as a vehicle for con- j 
veying the germs of disease. 

Bureau of Clinical Medicine. 99 

of such water. "Wells are dug within fifteen feet of sewers and old 
wooden drains, and within a few yards of privy vaults, and medical 
men of my acquantance say that they are fit to use. 

A medical friend of mine was called several miles into the country 
to see, in consultation, an entire family sick with typhoid fever. lie 
took dinner at the house and drank several glasses of water from the 
family well ; as a result he had a long siege of typhoid. When asked 
how he had been exposed, he could not tell, and the dangers of drink- 
ing water from this well had never occurred to him, until they were 
pointed out by a medical friend weeks afterwards. These are my 
reasons for calling your attention to this much discussed subject. 

I think that there is no longer any medical man who doubts that 
typhoid fever and choiora are contracted by breathing or swallowing 
the germs which have been contained in the excrement of former sub- 
jects of the disease. That these diseases never originate de novo, I 
shall not at present assert, but that, when once they are in existence, 
they are communicated, as I have indicated above, I believe no one 
will dispute. There is a city in this State of nearly one hundred 
thousand inhabitants, which for years has had a water supply from a 
river. From three to five miles above this city is situated a population 
of over one hundred thousand which has a very complete system of 
sewers into which are discharged thousands of water closets, besides 
all the washings of streets and all the filth of a great city. Think of 
the millions of intestinal parasites which are annually discharged 
through these sewers. Hundreds of cases of typhoid fever occur 
annually in this city, the discharges from which are thrown into these 
sewers. How can it be possible that the city below can escape drink- 
ing these parasites and germs. It is well known that they retain their 
vitality for weeks and months. It has been demonstrated beyond dis- 
cussion that diluting the fluid which conducts them does not destroy 
their vitality, and exposure to the air increases rather than diminishes 
their virulence. How many germs of typhoid fever would it be neces- 
sary to swallow to produce the disease ? How many particles of cuticle 
from a scarlet fever patient would be required to start a new case ? 
These germs would be transported from one city to the other in a few 
hours. Experiments and careful observations made in Europe by the 
best experts in the world, have demonstrated that dilution of contam- 
inated water does not greatly modify its power of conveying disease, 
uid that after being carried one hundred miles, in a running stream, 
t was as harmful as at the start. Recognizing this very fact, immense 
urns of money are being spent this fall and winter, in England, to 

Bureau of Clinical Medicine. 

buildings and apparatus to disinfect and render harmless sew- 
:i enters their rivers. I will not take the time of this 
> cite, from medical literature, the hundreds of eases which 
!Ord, where disease has been traced to a contamination of the 
supply miles away. You are familiar with them. 
>t which the laity almost universally commit, and into which 
sion is likely to fall, is that of placing confidence upon the 
a chemical analysis. It has been triumphantly asserted that 
1 analysis has proven the waters of a certain stream to be pota- 
liat therefore no further discussion is allowable. It has been 
uimerous instances that disease has been conveyed by water 
no adequate contamination could be detected by chemical 
.nd in which the microscope failed to show the germ which 
ischief. The only test for potable water should be absolute 
rom sewage contamination. 

; of the villages and in many of the cities of this country, 
in frequent use. We almost invariably rind them located 
iy regard to protecting them from drainage. I have seen 
it a farm house, a well fifteen feet from a privy and no farther 
place where all the slops were emptied. In West Troy the 
ill of them in the gutters, and most of them at the corners 
eets; at the present time, the stone work around one of them 
isturbed, eight feet below the surface, in the construction of 
nd yet a medical man who points out the dangers resulting 
l sources is not believed, and is even accused of having at 
tr motives than the public good. It is a common fallacy to 
lat by passing through a few feet of earth water is relieved 

nsive epidemics of cholera and typhoid fever, it has often 
;ed that only those persons were attacked who used a certain 
ited water supply. Epidemics of cholera have been partic- 
il and frequent in Holland, and it has been noticed by Ballot, 
dam, that these epidemics have been confined to those sec- 
re contaminated rivers, wells, or canals have been used as a 
ply. In those sections of Holland where cistern water alone 
lolera has never prevailed except as imported cases have 

ir duty as physicians to take high and positive ground on this 
We should never omit to call the attention of people to the 
ley incur, and particularly when public works, which are to 
ater for a large community, are being constructed. 

Bureau of Clinical Medicine. • 101 

is belladonna prophylactic in scarlet 

Fever ? 

By D. B. Whittier, M. D.. 


I propose to present a few brief propositions concerning the zymo- 
sis, the prophylaxis by Belladonna, and the popularly assigned methods 
of infection in scarlet fever. In 1883, Dr. Couch, of your Society, 
sought to procure a professional judgment upon the question ofVBella- 
donna as a prophylactic in scarlet fever, and his decision was based 
upon the majority of replies received. To the information, one hun- 
dred replied affirmatively, and twenty-live negatively ; the doctor, 
admitting the difficulty of submitting a satisfactory report, as the ques- 
tion involved possible differences in types, isolation, exposure and 
numerous other matters 'inherent in the subject. In view of the large 
majority answering affirmatively, I, one of the small minority, em- 
brace this opportunity for defending my position. 

At first glance the report appears conclusive, but before being 
accepted as the judgment of the profession, a stricter analysis of the 
subject should have been entered upon. Judgments formed from 
properly tested cases should be the basis, rather than from the opinions 
of physicians. By the method adopted, the opinions of a physician 
with a limited experience in this disease, and a careless analysis of his 
cases, often counter-balance the observations of one whose deductions 
are based upon a large experience, and an analytical comparison of cases 
which fit him properly for the position of arbiter. Considering the 
doubtful elements of ordinary clinical observations, does this decision, 
based on the testimony of one hundred physicians, point an effective 
prophylactic lance at scarlet fever ? I believe a thorough examination 
of this subject will disprove the claim. 

Zymoses. — It is conceded that scarlet fever is one of the best exam- 
ples of zymotic disease. Prof. Allen says that this class of diseases is 
never cured, but can only be conducted to a successful issue. Many 
other physitian3 have maintained the same proposition. Should it be 
thought that any one of the zymotic diseases has been arrested, a closer 
investigation will show the fallacy of such an idea. For whatever evi- 
dence of supposed convalescence is observed during the treatment, it will 

Bureau of Clinical Medicine. 

ards discovered that persons suffering from .such diseases will 
.1 until the typical limitation lias expired. If, then, a zymotic 
mot be arrested, can it be prevented; If an affirmative hypoth- 
tertained, and a drug administered, what action obtains '( 
that drug have an antipodal relation to the supposed approach- 
i ? Admit the germ theory as a casual factor. Can the drug 
ic germ either directly or indirectly ? Dr. Couch says, 

then succeed in killing out a natural order in the vegetable 
Sot at all ; it may be considered impossible to reverse any 
igenoiis vegetable development. These germs have existed 
d except from miraculous interposition, they always will exist. 
) expect to banish them from the arena of nature is as absurd 
1 be impossible." Deny this theory, and what morbid influ- 
! drug sent to arrest ; Whose penetration is sufficiently acute 
r the rational use of a drug without symptomatic, pathologic, 

casual manifestations? It was Prof. Allen, I think, that 
le organisms in perfectly healthy persons, and contended that 
not detrimental to a healthy state. 

axis. — Drugs have two actions in .the system, that which 
ind that which cures disease. Neither of these actions are 
;ic in the proper sense. The proper administration of a drug 
ed upou the presence of a known morbid element in the sys- 
his is not discoverable till constitutional derangement is evi- 

symptomatie phenomena. Jahr says, "When Belladonna is 
le invasive period of scarlet fever, its virus is held in abey- 
tically imprisoned in the system, and the external manifea- 
; is suppressed till the drug is withheld and the eruption 
) appear." Many others have confirmed this statement, 
evidence it appears that its use, previous to the fully devel- 
;ion, is suppressive, an injury, and thus its claimed prophylac- 
tics act as a mask. For it is the appearance of the eruption 
gn heralding it at the proper time that the physician anx- 
its, and this solicitude does not abate until the exanthem has 
ly appeared. The use of Belladonna as a remedial agent, 
arlet fever, is not determined until its second elective point, 
i reached. For when it is prescribed for its first elective 
throat symptoms, it is not then certain that the condition is 
s. The unhesitating disposition of physicians to prescribe 
■s a prophylactic, rests very largely upon the prestige of 
.n's recommendation. Yet if any of his learned disciples 

suggest such a proposition for experimental purposes only, 

Bureau of Clinical Medicine. 103 

it would be rejected at sight. His use of it, in a single case, proved 
successful, and he says, "I reason thus, a remedy that is capable of 
quickly checking a disease at its onset, must be its best preventive." 
This proposition was made, however, respecting the treatment of the 
Sydenham type, which has been, and is now, of rare occurrence ; con* 
sequently, it is not applicable in the present form of the disease. To 
anticipate and attempt to arrest the approach of a specific disease, by 
antagonizing its specific elements, is legitimate, in the spheres of 
hygiene and sanitation, but to attempt to eradicate from the system 
morbific forces whose presence is conjectural, is like directing an 
agent against an unknown thing of unknown origin. The period 
covering more than a half a century, during which Belladonna has 
been used as a prophylactic in scarlet fever, would seem to afford ample 
time to determine its exact value. We ought to know our weakness 
as well as our strength, and to attain this consistent position, gather all 
available facts that there may be less diversity of opinion in the inter- 
pretation of sequences. An analysis of my own cases in the last decade 
leads me to conclude that physicians have used the term prophylactic 
with too little consideration, and unwarrantedly have pursued this 
method of using this drug. 

Infection. — The nature and source of the infection of scarlet fever, 
and its spread, have been the subject of much discussion. Many and 
varied have been the theories presented to the medical world, but still 
it is in a sea of doubt concerning them. Investigation in the line of 
the germ theory has evolved nothing to demonstrate the existence of a 
specific germ as a casual factor, nor is the propagation of this disease 
by systemic susceptibility to any discoverable vegetable organism, 
accepted. It is commonly cited, and perhaps largely endorsed, that 
desquamating epithelial scales are vested with more infecting property 
than any invisible agents. Desquamation is a common product of exan- 
thematous diseases, and not a process peculiar to scarlet fever. It is a 
result of intense capillary conjestion, hypernutrition being followed by 
a diminution of nutrition below a normal point, when the epidermis is 
thrown off as dead material. The disclosures of the microscope, cited in 
the latest literature at my command, reveal neither germs nor any liv- 
ing organisms upon the exfoliated scales. What are found upon their 
surfaces are little hypenemic spots, which are not especial deposits of 
the poison. Recent tests have demonstrated that the scarlatinous exu- 
dations exhibit no effect upon animals by inocculation, and those organ- 
isms present in the secretions and excretions are accidental or a result 
of the disease, having no casual relation in its propagation. 


104 Bureau of Clinical Medicine. 

The proposition by the methods cited rests then upon an assumption, 
which has gained credence by its age, and by the fact that from lack of 
interest it has remained unchallenged by any great association of men 
until recently. In addition to this information, 1 am convinced from 
the scrutiny I have given this subject that the exfoliated epidermis is 
not a common carrier of scarlatinous poison, and consequently not an 
element of contagion. The small practical results from diverse views 
regarding the pathological condition, and the sequences, strongly sug- 
gest that the explorations in this field of medical knowledge have been 
without proper chart or compass. Since the decision by scientific inves- 
tigation, obtained with much difficulty, is after all uncertain, may we 
not with better results turn our attention to observations and tests 
which are analytical, detailed and recorded ? 

Illustrative of these views, I cite a few recent cases, as more accurate 
and detailed information can be obtained from those which are fresh in 
memory. The first case was sporadic, the sanitary conditions were the 
most unfavorable of any I shall present. The child was delicate, of a 
well-to-do and intelligent family, who used every precaution for the 
boy's health. The location was low, and probably damp ; near a brook 
which answered the purpose of a sewer. No other children in the 
families of the block or vicinitv were affected. This case was not 
unusually severe, except otitis as the sequel. As soon as the case was 
diagnosed the house was fumigated and disinfected for two weeks, and 
the remaining child in the family was quarantined in the lower part of 
the house and given Belladonna thrice daily. Four weeks after, the 
quarantined child was attacked with the disease ; case mild, not 
confined to bed, slight eruption, had otitis ; both cases desquamated. 
The next case occurred on the opposite side of the city ; sporadic also ; 
high altitude and good sanitary conditions. Was a typical case, otitis 
followed ; no evidence of a possible exposure to infection. The father 
and daughter were quarantined and took Belladonna three times daily, 
the father having had scarlet fever thought it unnecessary and soon 
discontinued its use. About ten days after the child's sickness, the 
father was attacked. Had some difficulty in diagnosing the case ; had 
inflammation of throat, without characteristic appearance of scarlet 
fever ; it resembled follicular tonsilitis, had a scanty papular eruption 
on the abdomen and back of the hands, persistent nausea and frequent 
vomiting, diarrhoea and great prostration, followed by desquamation, 
and a lingering convalescence. Twelve days after the father's attack 
the daughter was taken sick with what simulated gastric fever ; throat 
slightly congested, persistent vomiting, intense thirst, no eruption, 

Bureau of Clinical Medicine. 105 

temperature 103 degrees, great prostration, desquamated, gained 
strength slowly. During the attendance on these cases, I was 
called to a case of confinement in the lower tenement. The 
children in the family had taken Belladonna since the first case in 
the upper tenement ; no one of the family had the disease ; my visits 
to the families treated were made without precaution against infection, 
including the case of confinement. The next four cases were not under 
my care, but being in an adjoining house I had them under observa- 
tion. The first case in this family occurred two weeks after the first 
one in the last mentioned family. Care was taken in this latter 
instance, by isolation and ventilation, to prevent exposure to infection, 
and Belladonna was taken by all, except the first case, which was a 
typical one. Fourteen days after the first attack, three other children 
fell sick ; two of these cases were mild, the other severe, with 
glandular swelling as a sequel, with a slow recovery, all desquamated. 
The possibility of infection occurring in the first cases was eliminated, 
as was shown in each instance by every evidence which analysis affords. 
If the idea of infection is admitted, each family was exposed by the 
first case that occurred in it. 

The instance when infection should have been most imminent and 
disastrous was the parturient woman's. This fall (1886) have had three 
mild cases in a family. Children living in another tenement of the 
same house were purposely exposed, the mother desiring them to 
contract the disease while it assumed such a mild form. A month has 
now elapsed, and they have been, and still are, in their usual health. 
This kind of evidence produces conviction. These cases alone prove 
but little, but they, and numerous others more pronounced, current in 
medical publications, are important as showing by their development 
marked variance to the popular ideas regarding the illimitation of the 
infection and incubation of scarlet fever. This fact, taken with the 
failure of Belladonna to afford the protection claimed, confirm my 
experience during the last decade, that the view held by those 
professing such positiveness in these regards are unfortunate, if not 

The attempt to sustain a theory of alarmingly immediate, or an 
indefinitely postponed infection, corresponding to the emergency of 
the case, or the whim of the physician, in the absence of conclusive 
evidence, does not show a comprehensive conception of the disease. 
The procession of facts that may be presented by painstaking observa- 
tion, and analysis of cases, will prove the exceptions to the conventional 
idea of infection to be too frequent and too pronounced to prove the 


Bureau of Clinicai, Medicine. 

will be sufficient to disprove it. In summing up the 
idea on this subject, very many inquiries press for an 
t they are too numerous to consider here. I have no hesita- 
iserting my conviction that the statements made, and the 
;atliered, favoring the preventive power of Belladonna in 
- er, and the methods of infection in this disease, are fatally 
jy reason of the incomplete analysis of experience upon 
claims are based, also that the deductions drawn from them 
■ficial thought, or a manifest bias. The testimony of physi- 
erning the cause of scarlet fever, is that it is unknown, and 
3 spread, development, and complications, the unexpected 
ays happens ; that the wealthy classes are not exempt from 
, neither does altitude or sanitary excellence prove a barrier 
■ess, and ecu versely, that filth, bad sewerage, squalor, defective 
id poverty are not essential factors in its propagation, that 
numberless causes of immunity from it, despite prevailing 
ifection, and that the use of Belladonna causes no barrier to 
38. Problems are presented in all this testimony which 
tention. Only a decision based on an intelligent and adequate 
them can dispel the skepticism of physicians, and give to 
an intelligent and rational view of the subject. 


I. Gorham : In my experience there has been very little 
ver in this city for the past eight years (except isolated 
h every city lias I think), with the exception of last fall. 
le there were about fifty cases in the western part of the 
jstigation showed that the probable cause was due to drink- 
ter obtained from wells in that locality. Xow I submit that 
:rs of the Hudson are as contaminated as we are led to 
m the statements in the paper, if there would not be a great 
typhoid fever in this city than we have at present. 

rluxTiso : There are reasons for believing that many cases of 
ver are passed off as pneumonia, peritonitis and other forms of 
dy experience is, that previous to using river water I was 
led to treat a caae of typhoid fever, but since beginning its 
re that I have had none to treat. 

Bureau of Clinical Medicine. 107 

Dr. Henry C. Houghton: It has been a surprise to me to see 
many of our school expressing disbelief in certain apparent truths just 
at the time when writers of the old school are putting forth these 
beliefs. My first experience in the practice of homoeopathy was 
under the supervision of Dr. Joslyn, Jr.; coming out from old school 
experience in college and hospital, I was delighted in seeing these very 
same things, for I had never seen them before. It was his practice to 
give Belladonna to every person in a family where there was a 
case of scarlet fever. While serving under him at the Five Points 
House of Industry, I saw marked results from this treatment. The 
" day children," those coming and going every day, always received a 
dose of the Belladonna each day, whenever a case of scarlet fever 
appeared among the children. We had in one year over one thousand 
cases of children's diseases under our care and I only saw a few cases 
of this disease among them. 

Dr. M. S. Purdy : I would like to see this question of drinking 
water discussed more thoroughly. It is said by some that a well will 
drain an area equal to its depth. Is this true '( If so, we ought to 
know it. 

Some say that water is purified by passing through three feet of 
earth, while others say that notwithstanding the fact that it has passed 
through several feet of earth, the germs which produce disease are 
still present. 

Again, though chemistry may show the absence of inorgknic ele- 
ments, organic materials may be present in sufficient quantity to pro- 
duce disease. 

It seems to me that the medical profession ought to take more inter- 
est in this thing, and be more competent to instruct the people as to 
its importance. 

Dr. W. C. Latimer: People living in the country and in our 
smaller villages, ofttimes have an erroneous idea concerning the loca- 
tion of wells. They seem to think that if the well is placed on the 
upper side of the house or barn, there is no danger of contamination, 
taking it for granted that if the drainage is down hill on the surface, 
it must be the same below the surface. I remember about twelve 
years ago speaking to a physician in the western part of the State, that 
a certain well ought to be filled up, as it had become unfit for use, I 
thought. He replied that it was his opinion that the longer a well 
was used the better it became. It has since been shown that the water- 
shed underneath the ground was directly opposite to what it was on 



X . - 



108 Bureau of Clinical Medicine. 

the surface. This was discovered in boring for oil. As soon as this 
fact was known, water works were put in, and after that fevers pre- 
vailed to a much less degree in that place than formerly. Now I think 
if this subject was more thoroughly understood, and we were sure of 
the direction of the watershed, many of these troubles could be 

Dr. T. L. Brown : Standing water is more dangerous, than run- 
ning water. Many cases of scarlet fever, and other forms of disease, 
are caused by standing water or wells. Water, like many other things, 
is improved by motion ; the air itself is purified by falling rains. The 
boiling of water destroys many deleterious effects. I think the purer 
we can make our water the sooner we will cure our patients. 

Dr. J. L. Moffat : I think that one of the most important 
duties which the profession has to do, is to keep watch of all public 
works, especially the water supply of our cities and villages, as well as 
the matter of wells and plumbing in our own localities. We ought to 
have an influence in the community and exercise it over proposed 
public plans, no matter what. I was very much interested, when visiting 
Shanghai, in their water works. They have a system of double cis- 
terns. The water when taken from the river is thrown into a large 
receiving reservoir, where it is allowed to settle, and from there 
pumped into another reservoir, the process being repeated two or three 
times. This may be a little crude, but it is a practical step in the right 
direction, and one in which many of the systems in this country fail. 





Chas. F. Sterling, M. D., Chairman, - Detroit, Mich. 

Drs. George S. Norton, New York. 

F. Park Lewis, Buffalo. 

N. L. McBride, - -.--. New York. 

A. G. Warner, New York. 



By A. B. Norton, M. D., 


Frank D , pet. 15 years, Bristol, Conn., was 6ent to me at the 

New York Ophthalmic Hospital, on Sept. 7th, 1886, with a history of 
having been struck in the eye with a peach stone some two weeks 

He had received no special treatment, having only seen his physician 
the day before, who immediately referred him to me. Upon examina- 
tion I found the eye very red, from both conjunctival and scleral 

The iris was swollen, discolored, and adhered to the lens capsule ; 
pupil was contracted. There was a small amount of pus in the anterior 
chamber, and at the pupillary edge of iris ; extending outwards from 
the pupil was a small yellowish-white spot, a little larger than the head 
of a pin, which looked like a drop of pus resting on the iris. He had 
had no pain in the eye from the first, and the cornea showed no 

Bukeau of Ophthalmology. 

of having been wounded. The case at this time was diag- 
, as traumatic iritis. The patient was taken into the hospital, 

pad applied to the eye. Atropine used every hour, and 

he was given Hepar. 

first ten days lie was in the hospital (contrary to all expecta- 
made no material improvement ; the hypopion cleared up, but 
^s and the spot upon the iris increased a little. Then (while 
r the same treatment) the yellowish mass began to decrease, 
ew days had almost entirely gone, while the redness of the eye 
ttle noticeable. 

d. About one week ago the improvement ceased, and the eye 
etrograde and the cyst began to increase again. At present it 
le size of a split pea, reaching from the pupillary border to 

periphery of the iris, and is so prominent as to lay in contact 

th. Various remedies and applications have been used with 
; there is no change in the appearance of the mass since last 
e cornea has become a little hazy, and blood-vessels are seen 

from the outer border of the cornea to the point of contact of 
it!) the cornea. Under tlte influence of Cocaine I made an 
rough the cornea, at its outer side, about two lines from its 

and with the iris forceps grasped the tumor (which was 
avails breaking, and the contents became diffused over the 
hamber, acting as though encysted. At this time found no 

h. Eye healed quickly after the operation of the 24th, but 
soon refilled and assumed the same shape and appearance as 
Vday I again made an incision through the cornea with an 
' knife,passing the knife directly through the center of the mass, 
awing the knife blood and cystic fluid poured out. I then 

hard rubber scoop and removed from the mass a foreign 
!y the size of a pin's head, which proved to be a small piece 

stone, evidently the fine point at the end of the stone. After 
il of the foreign body the eye began to grow rapidly better, 

patient was soon discharged from the hospital. 
1. His physician wrote me to-day (in reply to my letter of 
lat there was then scarcely any redness of the eye-ball, the 
, clearing up, and some vision was returning. 
» ; This case is reported not as having brought any glory 
hysician (or I might say physicians, for he was seen at 
iines by every member of the staff of the Ophthalmic 

Bureau of Ophthalmology. Ill 

Hospital), but rather as a warning in future cases. The fact of a 
foreign body being in the eye was often discussed, but as pften discarded, 
because from the nature of his injury (being struck with a peach pit), 
could not believe that any portion of it had penetrated the eye ; 
further, the cornea showed not the slightest abrasion from the first, and 
nothing could be seen in the iris. 

Foreign bodies in the iris are apt to cause cystic tumors by a doubling 
up, or a folding over of the iris upon itself, with a retention of aqueous 
humor secreted by the iris, and a gradual distension of this fold. They 
have a tendency to increase in size, endanger the eye, and even threaten 
the other eye through sympathetic irritation. Foreign bo'dies have 
become encysted in the iris without causing any irritation of the eye, 
but this is so extremely rare that we are not justified in allowing them 
to remain. The treatment should be to remove the foreign body at 
once, and I believe in this case of mine, if the foreign body had been 
recognized and removed when he first came under my care, that the 
results as to vision, etc., would have been more favorable, but it was 
with me, as with one of the older surgeons, who remarked that no 
similar case had ever fallen under his observation, and although the 
final results demonstrated that the eye should have been opened earlier, 
at the time the indications did not point to any operative procedure. 

112 IjLKeau of Ophthalmology 


By F. Park Lewis, M. D., 

BUFFALO, x. y. 

The following case is reported because, as far as the writer is aware, 
it is unique in the history of Basedow's disease, and he desires, there- 
fore, that it be placed on record : 

The patient, a woman of nervous sanguine temperament and slight 
build, had been married for five years. She was twenty-six years of 
age. Had been in good physical condition until %he birth of her 
child, one year after her marriage. Nothing of unusual interest had 
occurred during her pregnancy, but her labor was protracted and 
severe, and was followed by delirium lasting for several days after her 
delivery. During the three months following she suffered more or 
less constantly from metrorrhagia. Since that time she had never been 
well. She had been rather more nervous than usual, when, three 
years ago, it had become evident to her that her heart was beating 
more rapidly and with more forcible impulses than was normal. This 
continued without intermission, and in August, 1885, her left eye 
began to protrude until, in a few days, it had become alarmingly 
prominent. This proptosis had been accompanied and^was followed 
by intense pain in the left temple and left eyeball,' exacerbations 
occurring at irregular intervals, usually about a week apart, there 
being meanwhile a more or less constant dull aching in the eyeball 
and temple. Occasionally sharp neuralgic pains would dart through 
the right eye and temple, but infrequently and with no regularity. 
The more severe attacks were followed by general prostration. 
Her dreams at night were horrible, quite frequently of falling from a 
great height, and she would awake to find herself sobbing. She com- 
plained of frequent sharp uterine pains, but an examination, made at 
the writer's request by Dr/T. 6. Martin — who was then attending 
physician at the Homoeopathic Hospital where she was being treated, 
disclosed no abnormality. Her menstrual periods were regular. No 
organic lesion of the heart could be discovered. Her pulse at the date 
of her first visit was 98. The proptosis, she had noticed, was always 

Bubeau of Ophthalmology. 113 

increased by anxiety or nervous excitement. The heart beats at such 
times were also more rapid and forcible. Frequently, before the eye began 
to protrude, she had attacks of congestion of the head, with dizziness, fol- 
lowed by blowing dark blood from the left nostril. She had frequently 
been short of breath, and had been troubled with hot flushes followed 
by chills. For the three months preceding her first visit to the writer, 
together with the pain in the left eye and temple had been a severe 
pain, in the morning on rising, in the neck and back of the head. 
With the pain in the head had been a beating in the ear on the side of 
the pain, sometimes on one side and sometimes on the other. Before 
the protrusion of the eye, beating was felt in the orbit synchronous 
with the pulse. Digestion was good ; her habit constipated. She 
complained of a constant feeling of hunger not relieved by eating. 
Her appetite had been moderate. A careful examination of the eye 
discovered no organic change other than the unilateral proptosis. 
Pupils normal in size and responding readily to light and accommoda- 
tion. Media clear, retinal and optic nerves normal. No pulsation 
discoverable in the retinal vessels. 

The direct history of this condition was one of domestic infelicity 
with actual physical suffering. During her post-partum illness she had 
been deprived of necessities of life, and had suffered from exposure to 
intense cold. She had been continuously in a state of nervous excite- 
ment which was kept under repression, the tension being thereby 
greatly increased. 

Hare cases are reported of monocular exophthalmia in morbus 
Basedowii, but none, as far as the writer is aware, have been published, 
in which, with unilateral proptosis, the thyroid enlargement has been 

Incidentally it may be remarked that the curative remedy was Nux 
moschata, a drug which bears in many respects a close analogy to 
the disease, and which has subsequently, in an incurable case with 
enlargement of the heart, proven of great value in controlling many 
of the nervous symptoms. 




Dillow, M. D., Chairman, - - New York City. 

L Bull, Buffalo. 

1. Jones, ' Albany. 

pin, Brooklyn. 

. Shklton, .... New York. 

J* Leal, New York. 

ohlkt, New York. 

sue Remedies in the Treatment of 
hseases of the air passages. 

By L. A. Boll, M. D., 


ago, in this place, Dr. Houghton read a paper on the 
sane Remedies, giving the results of his experience and 
others investigate and report. His presentation of the 
tly interested me, and caused me to study these remedies 
ects, with the result that for the past nine months I have 
y anything else. My paper will be in the nature of a 
; remedies, and what I have been able to do with each, 

Phos. I frequently begin the treatment of chronic 
mditions of the air passages with Cal. phos. I find 
quite a decided tonic action and influences the con- 
; membranes for good ; in many cases it quite takes the 
Cinchona preparations. In the headaches of children and 
[ rarely need anything else. In the coughs of consumption 

Bureau of Laryngology. 115 

(chronic), and in the general condition presented in incipient phthisis 
it does good work. Scrofulous enlargement of the cervical glands 
frequently yields rapidly to its use. 

Galcarea Sulph. This remedy I have used only in its catarrhal 
sphere, i. e. where the secretions are thick, yellow, opaque and fre- 
quently tinged with blood. Here it acts nicely, quickly clearing up 
the condition of the mucus glands. One case of bronchitis, in the 
stage of resolution, was very favorably acted upon by it. 

Calcerea Fluoride. I have prescribed C. f . in but two cases, which 
I will let speak for themselves. 

Case I. An injury to the tibia of some years standing ; the growth 
which came on the seat of this was very painful and had been 
diagnosticated as osteo-sarcoma by a prominent surgeon, who advised 
operation. When she came into my hands, some time after, I gave her 
Cal. fluor., which relieved the pain, and, my latest report, is reducing 
the growth. 

Case II. A man with symptoms of secondary and tertiary syphilis 
presented himself, showing the inferior turbinated bone and part of 
the vomer from the right side which he had discharged through the 
mouth. The odor from the nostril was horrible and was not mitigated 
in the least by various sprays and the internal administration of Merc, 
and Iod. pot. Finally he was put upon Cal. fluor., and a spray of 
H 8 2 used once a day to thoroughly clean out the nostril ; from this 
time he began to improve; the sanious discharge ceased, being 
replaced by frequent effusions of blood, showing that granulation was 
taking place, and the rapid relief from the odor was proof that the 
dead bohe was being covered by a healthy structure or had been 
cast off. 

Ferrum Phos. This remedy disappointed me at first, but famil- 
iarity with its action raises it higher (daily) in my estimation. 
With me it takes the place of Aconite, and witfi this addition that it is 
good in localized (inflammation) as well as general. I have used it in 
some terrible cases of pulmonary congestion, and it carried them 
through without any other remedy being required. With it I have 
cured the sore throats of singers while they were using the voice daily. 
I have had to thank Dr. Houghton for the hint given in his paper of 
last year for singers to dissolve a tablet on the tongue just before 
singing. Ferrum phos. has stopped a tendency to frequent nosebleed 
in rapidly growing children. 

Bureau of Laryngology. 

*. In the treatment of throat troubles I now give K. m. 
nerly gave the Mercuriee. I have had no occasion 
iphtheria, but in sub-acute inflammation of the air passages 
; ailed me, when given according to its indications. I give 
ases having white coated tongue, superficial abrasions of 
hiek tenacious secretions of either opaque, white, or of 
:en. I find it about my best remedy in those cases where 
it forms in the vault of the pharynx. In a case of this 
was gratifying to see the eyes were cured of a chronic 
j this remedy, given to relieve the nasal symptoms. 
». This helped very materially a gentleman who, suffer- 
ihronic pharyngitis, had a most fetid perspiration under 
I have seen it benefit jn sleeplessness due to business 

old catarrhal subject who came down with sciatica of a 
type rapidly recovered under Kali phos. and suitable diet. 
•h. My use of this remedy has been confined to 

the typical yellow slimy secretion ; in a few cases it has 
. I have also used it in cases of running ears when the 
s thin, of bad odor, and yellow in color. 
■» Phos. One of the most troublesome class of cases 
had to treat has been that -of chronic pharyngitis with 
)ugh. These cases come firmly believing tliat they 
ption, or some chronic lung trouble nearly as had. They 
le spasmodic cough which they usually refer to the pit of 
d of course the lungs are sore from the strain of coughing. 
s Mag. phos. will often surprise one by the quick relief it 
[n other cases of chronic pharyngitis, with thickening of 
of the pharynx, there is often choking on attempting to 

swallowing a larger bolus than usual. In this class Mag. . 
'es great relief. 

Wur, One ease of nasal catarrh which I was treating 
told me that it caused a very manifest reduction in 
hydrocele, with which he had been troubled for years and 
ien frequently tapped. In catarrhs where there is a thin 
irge, worse on going into the cold and on exertion, N. m. 

Phos. This remedy I have used but twice, and then as 
;nt when gastric symptoms, acid risings, etc., came on. 
n the indication of the yellow coat at base of the tongue 

Xairum StlpA. Use of this remedy has also been confined to pre- 
scribing for intestinal tro-ibles, occurring in ease* under my charge, 
for catarrhal complaints Bat in dispei*sary practice I hare seen two 
cases of photophobia in sero talons ophthalmia resist almost every- 
thing else and be relieved bv X. Sw 

Silicea- The best results obtained by me during the past year have 
come from Silicea. Several were in cases of chronic pharyngitis* com- 
plicated with constipation, in one case of twenty five, another twenty 
years, and a third still longer standing, these cases were cured with 
Silicea. The first case dates back to a traumatic paralysis from the 
waist down. The paralysis passed off but left constipation. Another 
case, a man. a hay fever subject* spoke to me early in the spring about 
his feet, they were so insufferably tender. A prescription of Silicea 
cured him of this distressing feature, and when his hay fever time 
came I gave him the same remedy with the gratifying result of almost 
entirely relieving him. He had, after severe exposure, some running 
of the nose, and on the hottest day of the summer some sneezing and 
burning, otherwise he was able to attend to his business and be exposed 
as never before. 

In conclusion let me say that he who thinks that, because there are 
but twelve remedies, he therebv finds things easv in the wav of cor- 

. ~ at « 

rect prescribing, is very much deluded, and 'will certainly find it out 
very shortly after beginning such practice. 


Dr. G. AL Dillow: I think that peroxyde of Hydrogen had 
very likely much to do with the cure of one of the cases reported. It 
would be difficult to say how much influence should be ascribed to the 
Calcium fluoride and how much to the Hydrogen peroxide. 

How do you differentiate between the remedies I Do you follow 
the indications as given by Schussler, or by the appearance of the 
parts as learned by experience ? I do not think we have a homoeo- 
pathic remedy unless it has been so shown by the provings of healthy 
persons. Some of the Schussler remedies have been proven, but not 
11. A good deal of light is thrown upon their action by provings 
ilready made. There is a good deal of empiricism in our school 
o-day, which ranks as homoeopathy because small doses are used. We 

#:-.cV-.S- •* •• r 


118 Bureau of Laryngology. 

all ought to keep clearly in mind the distinction, that homoeopathy is 
the application of drugs in accordance with the law of similars based 
upon effects obtained by provings upon healthy persons. 

Dr. L. A. Bull : In the treatment of my cases where I have a 
pathological condition, such as a growth, et cetera, I use local reme- 
dies, but where the trouble seems to arise from some dyscrasia, I use 
only internal remedies. The cases reported were treated almost entirely 
with internal remedies. »I use the fourth decimal trituration. 
..* In reply to Dr. Dillow's question I will state that I have been guided 
by both Schiissler's indications and my own experience. In beginning 
to use these remedies I remembered a lecture by Prof. T. F. Allen, in 
which he stated that the continued use of Iron or other proximate 
principles of the body, would cause the loss of these principles in the 
body. Taking this remark into consideration I thought that we could 
use these remedies homoeopathically, knowing the tissues in which they 
ore found and the diseases their absence causes. 




Thos. D. Spencer, M. D., Chairman, - - - Rochester. 

Drs. M. 0. Terry, Utica. 

J. M. Lee, Rochester. 

Geo. Allen, Waterville. 

L. L. Brainard, Little Falls. 

Newton M. Collins, - - - - - - Rochester. 

With invited co-operation of Drs. H. C. Frost, Buffalo, and H. I. 
Ostrom, New York. 

Disputants : Drs. M. O. Terry and J. M. Lee. 


By M. O. Terry, M. D., 

utica, n. y. 

At the regular monthly meeting of the Homoeopathic Medical 
Society of the State of New York, which was held in Albany during 
the month of February, 1884, I read a paper which recited in brief 
twelve cases of spinal and periosteal irritation, cured or greatly 
benefitted by the instrument known as Paquelin's Thermo-Cautery. 
Prefixed to this paper were quoted various authors, who had given this 
subject great attention. No claim of originality will be entertained by 
myself as to the treatment of these cases, but simply the credit of the 
publication of the Jirst series of cases, thus drawing the attention of 



:ifession to a treatment which I consider superior to any 
We say superior to any, for the reason that many cases, 
them, had been under the care of physicians of 
10 had used the various remedies and auxiliary treat- 
ig the galvanic current, blisters, cupping and leeches, 
^ere made from the writings of Hammond, Beard, Lilien- 
Iramwell, Martin Kershaw, Sequiu, and H. B. Millard, 
vriters. Having by a stroke of good fortune come into 
>f quite an ancient work on this subject, I shall take the 
ing from it the practical suggestions relative to the 
urea of symptoms of spinal irritation. The work is that 
ridgin Teale, and has for its title : " A Treatise of 
ases Dependent upon Irritation of the Spinal Marrow, 
: the Sympathetic." It was published in Philadelphia 

includes within its range a great variety of diseases, 
endless diversity, both in their symptoms and in the 
:y are seated. 

variety should exist ceases to excite surprise, when we 
varied are the functions of the different nerves, and 

the tissues and organs to which they are distributed. 
entive observer of disease, neuralgic affections, under 
inded signification, must repeatedly represent them- 
skin, for instance, may be the seat of every degree of 
linished sensibility, from the slightest uneasiness to the 
ering, and from the most trivial diminution of sensi- 
lete obliteration of feeling — symptoms not dependent 
, affecting the different tissues of the part, but solely 
norbid condition of the sentient nerves. The volun- 
nay, in like manner, indicate, in a variety of ways, a 
on of the nerves with which they are supplied. They 
d with weakness, spasms, tremors, or a variety of other 
es included within the two extremes of convulsions 
The involuntary muscles may have the harmony of 
iterrupted, from a morbid condition of their nerves; 

be affected with palpitations; the vermicular motions 
l, or the peristaltic action of the intestines, may be 
gnlarity. The sensibility of the internal organs may 
ected ; the heart, the stomach, the intestines being the 
ferable to their nerves, and independent of inflammation, 


Bureau of Surgery. 121 

or any alteration of structure. The secretions may also undergo 

alterations, both in quantity and quality, from a perverted agency 

of the nerves upon which they depend. 


" The difficulty and embarrassments which have attended the diag- 
nosis and treatment of these affections, I am inclined to believe, has 
principally arisen from mistaken views of its pathology. They have 
too often been regarded as actual diseases of those nervous filaments 
which are the immediate seat of the neuralgia, instead of being 
considered as symptomatic of disease in the larger nervous masses 
from which those filaments are derived ; hence, the treatment has too 
frequently been ineffectually applied to the seat of neuralgia, 
instead of being directed to the more remote, and less obvious seat 
of the disease. 

" There are many individuals in whom the complaint has existed, in 
varying degrees of intensity, for a series of years, without its real 
nature having been suspected ; the patients and their medical 
attendants having regarded it throughout as a rheumatic or a nervous 
affection. In this complaint, tenderness in the portion of the 
vertebral column, which corresponds to the origin of the affected 
nerves, is generally, in a striking and unequivocal manner, evinced 
by pressure. In some instances the tenderness is so great that even 
slight pressure can scarcely be borne, and will often cause pain to 
strike from the spine to the seat of spasm, or neuralgia. 

u The symptoms, of course, vary considerably, according to the 
particular part of the spine which is affected, and bear reference to 
the distribution of the different spinal nerves." 

My principal object in making these quotations is to direct your 
attention to the necessity of ever being on the alert for reflex symp- 
toms. That physicians are frequently misled by them, my experience 
has shown to be the case. Women are the more common victims, and 
when they complain of frequent headaches, especially in the occipital 
region, extending over the scalp, causing pains and disturbed vision ; 
constant feeling of being tired, more particularly in the morning ; 
rheumatic pains in various parts of the body, as between the shoulders, 
in the lumbar or dorsal region, or in the chest, without a history of 
pneumonia. If they have an occasional dry cough, it will be well to 
run the fingers over the spinal vertabrse, using gentle pressure, to 
ascertain if they are sensitive. It will readily be seen that a study of 
the distribution of the spinal nerves will be of great value to assist in 
tracing out these disagreeable, teasing, functional disturbances. 

~* i . 



a *;; . 

122 • Bureau of Surgery. 

|s N To show the results obtained by the author of the work published in 

Lit' -i \^~\ 

|{;'.:}.* 1830, and to show also the fact that other methods than the thermor 

||j > v cautery have given satisfaction, I will quote his words on that subject ; 
fe*>'-: " Local depletion by leeches or cupping, and counter irritation 

jj ;•';•;' ty blisters, to the affected portion of the spine, are the principal 
|£v '. remedies. A great number of cases will frequently yield to the 
single application of any of these means. Some cases, which have 
even existed for several months, I have seen perfectly relieved by the 
single application of a blister to the 6pine, although the local pains 
have been ineffectually treated by a variety of remedies for a great 
,length of time. A repetition of the local depletion and blistering is 
however often necessary after the lapse of a few days, and sometimes 
is required at intervals for a considerable length of time. In a few 
very obstinate cases issues or setons have been thought necessary ; 
and where the disease has been very unyielding, a mild mercurial 
course has appeared beneficial. 

" It is of course necessary that proper attention be paid to the regular 
functions of the bowels, and to the treatment by appropriate means 
of any other affection which may co-exist." 

When there is a tendency to relapse, he uses a stimulating liniment 
to the spine for a few weeks, composed of one part of spirit of 
turpentine and two of olive oil. 

The Treatment of the sac, in the Radical 

Operation for Hernia. 

By H. L Ostrom, M. D., 


The best method of dealing with the hernial sac, has been discussed 
since the earliest attempt made by surgeons to preform an operation for 
the radical cure of hernia, for with a knowledge of the anatomy of 
the structures involved, the importance of the relation of the protrud- 
ing peritoneum to the other parts of the rupture, could not fail to be 
recognized. This subject, therefore, though one of great interest, and 
one, the correct understanding of which must influence our percentage of 
cures, has been worn thread-bare ; I think, however, that something 
remains to be said, if only to emphasize the opinions with which you 
may already be familiar. 

Bureau of Surgery. 123 

The minute anatomy of hernia, belongs to. and may be found in 
any text-book of anatomy, this need not therefore detain us. The 
points I here wish to illustrate, and which seem to me to be essential 
to a clear understanding of the principles upon which the radical cure 
of hernia must be conducted, are, first, the anatomical and physiologi- 
cal peculiarities of the peritoneum ; and, second, the degree of strength 
that the peritoneum affords to the naturally weak parts of the pelvis. 

It is very evident that the peritoneal sac, when compared with the 
muscular tissues through which a hernia protrudes, is of secondary 
importance if the question is one of permanently closing the abdom- 
inal opening, and restoring the continuity of the abdominal walls; but 
I think it capable of demonstration, that regard to what may be 
called the physiology of the hernial sac, will greatly aid to strengthen 
the mechanically closed opening in the abdomen, and tend to seal 
internally the newly formed line of union. 

We will assume that the operation involves laying bare the hernial 
6ac, and holding the borders of the opening in apposition, after they 
have been rendered surgically capable of uniting. At this stage of 
the operation we have lying between the vivified muscular fibers out 
of which it is hoped to form cicatricial tissue, a blind tube composed of 
serous membrane. The question therefore arises, shall we return this 
intervening tissue into the abdomen, and direct our efforts towards 
establishing immediate union between the muscular borders ? Or shall 
we allow the peritoneum to occupy its abnormal position, and incor- 
porate it in the inflammatory new formation that it is our design to 
establish for the purpose of resisting visceral pressure ? Our answer 
must be based upon both anatomical and clinical data. 

The easy distensibility, and marked elasticity of the peritoneum, as 
of all serous membranes, affords little reason to expect much of this 
structure, in the way of guarding the hernial opening from a protru- 
sion of the intestines. Simple restoration of the integrity of the peri- 
toneum, can therefore exert no direct effect upon the permanent clos- 
ure of the abdominal lesion, for the perfectly healthy membrane 
requires only a slight force to push it forwards, but a peritoneal cicatrix 
yields to even less pressure from within, as every laparotomist can 
prove from his own experience. Now it is plain that these same qual- 
ities of distensibility and elasticity that belong to the peritoneum gen- 
erally, will not be lost when this membrane is incorporated in the cica- 
tricial tissue that closes the abdominal opening ; and it is equally plain 
from the position of the peritoneal cicatrix in the center of the new 
tissue, that mechanically this structure will be the first to yield to 


124 Bureau of Surgery 

intra-abdominal pressure, and as a consequence, will favor a return of 
the original visceral dislocation. If we could say that a serous mem- 
brane is destroyed when held between two muscular surfaces that 
are in a condition to unite by plastic exudation, the objection here 
advanced to including the peritoneum in the sutures that bring the 
opening together, would have little weight ; but I am not acquainted 
with any experiments that prove the possibility of such a structural 
metamorphosis. It is probable that a serous membrane always remains 
such, and that when it forms a part of a reparative inflammation, it 
does not lose its distinguishing features. Any operation, therefore, for 
the radical cure of hernia will be anatomically incorrect, if the perito- 
neal sac is allowed to remain between the pillars of the ring throngh 
which t|ie intestine protrudes. 

Though reference is here made especially to the management of the 
sac in cutting operations, it will be found that clinically the best results 
are obtained by the maneuveurs that invaginate the sac, and seek to 
bring the margins of the opening, and the canal when one exists, in 
direct contact. In Heaton's operation, the sac is at least temporarily 
pushed into the canal ; and in Wiitzer's method, a very excellent pro- 
cedure, when for any reason the more severe and extensive operation 
is undesirable, a very essential feature is invaginating the peritoneum 
upon the cylindrical instrument that aids in sitting up adhesive inflam- 
mation. In Wood's operation, probable one of the most successful 
that has been proposed for the radical cure of hernia, the fundus of 
the sac is in vagina ted upon the finger before the needle is passed 
through the ring, indeed one of the objects of this operation is to 
return the peritoneal protrusion, and to retain it within the abdomen. 
But these conservative methods have one common objection; they 
more or less imperfectly return into the abdomen a certain extent of 
peritoneum that has become greatly distended and relaxed while sur- 
rounding the protruding viscera. Moreover, the use made of the sac 
is at variance with what is known of its physiology, for it is designed 
to make it a principal part of the cicatricial tissue. This portion of 
peritoneum can neither in the abdomen, nor in the hernial canal, be of 
any great service, and, therefore, it is better to amputate it as close as 
possible to the external abdominal opening. 

Since in 1826, when Lembert demonstrated in reference to suturing 
the intestines, that serous surfaces brought in apposition unite rapidly, 
many abdominal operations have been made possible that previously 
were theoretical. Applying the French surgeon's discovery to 
the treatment of the hernial sac, we find that it is only necessary to 

Bureau of Surgery. 125 

make the sac a closed canal, and to stitch it through and through, to 
insure a good and firm union of its surfaces. But no additional 
strength is gained by having this union extend the entire length of the 
canal, therefore, and because it is desirable to bring the edges of the 
opening in direct contact, the distal end of the sac should be removed. 
Some operators prefer to tie the sac, and return it as a plug to the 
abdomen, but such treatment does not appear to add to the success of 
the operation, and it lacks the scientific accuracy, and the elegance, 
that should belong to every surgical procedure. 

The operation for the radical cure of hernia with which I have lat- 
erally been most successful, combines several methods, especially those 
of some English surgeons. It will be observed that my treatment of 
the 8ac, with the exception of the method of obtaining union of its 
surfaces, is the same as that adopted by Mr. Lucas, of Guy's Hospital. 

After thoroughly exposing the whole length of the sac, so that an 
opportunity is afforded to break up any external adhesions that may 
exist, the contents of the sac is returned to the abdomen, and the neck 
of the sac sewed with fine silk. The redundant sac, being virtually 
strangulated, is then cut off, and the sewed, or proximal portion, 
allowed to retract within the abdomen. After excising the ring with 
Emmet 8 convex scissors, aided with a tenaculum, very much as we 
operate on a lacerated convex — this I consider an essential feature of 
the procedure — its edges are held together with rather fine silk, the 
round, slightly curved needle being made to enter, and emerge, half 
an inch from its free border. The sutures are sufficiently numerous 
to hold the free edges in perfect contact, and are tied rather tightly, 
their ends being cut short. A drainage tube is inserted, and the 
external wound sutured with silk 

In this operation an attempt is made to restore the natural relations 
of the parts. The peritoneum is preserved as the continuous lining 
of the abdomen, and the abdominal opening is simply closed, as before 
the protrusion took place. 

126 Bureau of Surgery. 




By L. L. Brainard, M. D., 


During the past year I was summoned to make a post-mortem 
examination on the body of a man, who died from the effects of bullet 
wounds through the upper third of each thigh. The primary cause of 
death was not known until revealed by the examination, although the 
case was attended by three physicians (all old school), one of whom 
claimed considerable surgical experience. The man who fired the 
shots is charged with murder, and will soon be tried ; one of the main 
grounds of the defense will be malpractice in the treatment of the 
wounds. It is for this reason that I make this case the subject of my 
paper ; not that I expect to contribute anything ne\v*in the treatment 
of gunshot wounds of arteries, but I deem the case, from the obscurity 
of the symptoms, worthy of consideration by the physician as well as 
the surgeon. 

The man was shot while engaged in a melee in his own saloon ; he was 
carried up stairs to his rooms ; complained of pain and numbness in the 
left foot ; no hemorrhage to speak of. Upon examination two bullet 
wounds were found, one in each thigh, near the apex of Scarpa's triangle. 
The shots seemed to hare been fired from in front, and the missiles passed 
out posteriorly, somewhat below a level with the point of entrance. On 
account of there being no hemorrhage, and the existence of a counter- 
opening in each thigh, showing that the bullets had passed out, nothing 
was done but to apply compresses to each wound, bandage the thighs, 
and ad vise perfect rest. But pain became so severe in the left leg 
that a hypodermic injection of Morphia was given, and used more or 
less until the end. The injury of the right thigh proved to be a simple 
flesh wound, and it gave no trouble; cicatrization was nearly complete 
when death occurred. 

Bureau of Subgeby. 127 

The left leg, however, became cold and senseless ; the toes looked 
dark on the fifth day ; gangrene fully developed, and rapidly extended 
to the body. When I saw him, on the eighth day, it involved the 
scrotum, the gluteal and inguinal regions, as likewise the abdomen. He 
died on the tenth day, of septicaemia. 

The autopsy showed that the left femoral artery had been perforated 
just below the profunda femoris, on its upper aspect ; also that the 
vein had been opened and the nerve slightly cut There was a diffuse 
traumatic aneurism, involving the muscles to the knee ; dark coagula 
burrowed under the sartorius and infiltrated the quadratus femoris to a 
large extent — all of which were in a decomposed state. Here was the 
evident cause of death : Punctured wound of the femoral artery and 
vein ; diffuse aneurism ; gangrene ; septicaemia. 

Now, the question is, could this have been diagnosed soon after the 
injury, and what should have been the treatment ? 

To a practical and experienced surgeon, the question undoubtedly 
seems simple and the answer easy ; but to us less favored ones, the 
problem may be«worth of consideration, that we may be prepared for 
similar emergencies. All the modern works on surgery lay down the 
symptoms of wounds of arteries (punctured or incised) to be hemor- 
rhage ; absence of pulsation in the distal extremity of the injured 
vessel and coldness of the parts supplied by the same ; but the " key 
note " is primary hemorrhage, and the one which calls for immediate 
treatment. Without this we are somewhat in doubt, and need to wait, 
or explore and find the extent of the injury. In this case there was 
hardly any hemorrhage to be seen ; the tension of the thigh was 
increased to some extent, but not marked ; the pulsation in the tibial 
arteries was absent. This ought to have excited suspicion, yet one of 
the best and most elaborate authorities on wounds of arteries with which 
I am familiar, Lidell, {International Encyclopedia of Surgery), says — 
and cites case to show — that a contusion of an artery from a bullet may 
stop the pulsation in the distal extremity of the vessel, and be followed 
by coldness, numbness, etc., and still result in recovery without any 
treatment other than rest. Therefore we must wait and watch, and if 
gangrene appear in the extremity, the diagnosis of injury of an artery 
would be very certain. 

The treatment in such cases requires the most careful consideration. 
The surgeon, even of great experience, is often brought to the deepest 
meditation as to what shall be the best course to pursue that " life and 
limb" may be saved. On one hand the "vis medicatrix naturae" 
must not be lost sight of, while on the other, the indications presented 

Bureau of Surgebt. 

et, and thus save the too often post mortem revelation and 
" It might have been." 

hemorrhage should be checked by immediate compression, 
roximal and distitl ligatures applied as soon as possible. But 
is like this, no external hemorrhage occurs. This is some- 
;o moving the part immediately after the injury, which 
muscular planes to slide past one another and compress the 

condition the tissues are apt to be infiltrated, and the 
s more of a question. The ligatures would not contribute 
; limb, unless applied immediately; the tension from the 
would prevent the collateral circulation from going on ; 
; down upon and turning out the clots to any great extent 
very doubtful procedure. It seems to me that the treatment 
ondition would be to prepare well for sudden secondary 
3, and wait ; and at the first appearance of gangrene, 
be in the toes, amputate immediately above the injury, high 
good healthy flaps, which in this case would have been at 
it, or possibly just below the trochanters, either of which is 
le operation, and attended by a high rate of mortality. But, 
iding that, the duty of the surgeon would be done, and no 
eglect would rest upon his shoulders; the cause of death 
placed where it belongs, to the assailant. I am indeed 
;at this neglect to amputate at the proper time is not 
homoeopathic snrgery ; for if it were, the old cry, which 
n even mentioned in the last decade, that " Homoeopaths 
■r children, but they are no surgeons," would be resurrected, 
icularly, would have to submit to the taunts of the so-called 
' the old school, to the end of their desires. So if any one 
ety shall be given an incentive, by the history of this case, 
*r prepared for dealing with similar cases, it will be the 
my anticipations for this paper. 

/ ' 






By J. M. Lee, M. D., 


Case I. Mrs. J. T., widow, aged 62 years, resident of Seneca 
county, and mother of two children. Abdominal section, Dec. 4tli^ 

1884, and a thirty-six-pound unilocular ovarian cyst, four years grow- 
ing, was removed. A single silk ligature was placed about the thick 
pedicle, which was cauterized, and left inside. The abdomen was 
closed with silver wire and Calendula dressing applied. Uninterrupted 
recovery ; highest temperature, 100. Returned home the fifth week. 

Case II. Mrs. P. P., married ; aged 61 years ; resident of Steuben 
county, and mother of five children. She had been well, up to 
within five years previous to coming under my observation in April,. 

1885. During this time she had consulted many physicians and 
patronized not a few infirmaries and u cure-all " establishments. The 
various forms of baths and prescriptions produced no beneficial 
effects ; and she received as many discordant opinions of the cause 
of her disease as she had medical attendants. One thought all her 
sufferings came from " retroversion and ulceration." Another consid- 
ered her a "hypochondriac," and that "by proper management she 
might be restored to health without much medicine." This plan of 
treatment included, however, the free use of anodynes r and she went 
from bad to worse until her nervous system was completely broken 
down, and, when she came under my care, she at times was thought 
to be insane. 

An examination revealed a multilocular cyst extending high up in 
the abdomen, giving it a prominent and flattened appearance. On 
May 4th, 1885, about a month from the time I first saw her, I per- 
formed ovariotomy, removing an eighteen pound tumor. The pedicle 
was secured with silk, cauterized and dropped back into the pelvic 
cavity. The abdomen was closed with silver wire, and wound dressed 
! with Calendula. The healing process was by the first intention with- 

out fever worth noting, or bad symptoms of any kind except those 


eable to withdrawal of her accustomed anodynes. These 
'mptoms were exceedingly annoying and caused me incom- 
re trouble than all the other treatment, 
hed, cried, imagined she saw familiar forms or faces in her 

she had abscess of the liver, or other equally dangerous 
ns, and summoned her friends to the bedside to see her 
ithin an astonishingly brief period. These scenes were not 

yet her condition otherwise remained normal. By means 
iate treatment she returned home the fifth week, cured, not 
! tumor, but also of the opium habit resulting from the 
treatment of the " scientific school," 

. Mrs. C. D. C, of Genesee county, aged 41 years ; eleven 
ed, but never pregnant. Had noticed abdominal enlargement 
ire. At the first consultation, about five months ago, the 
as rather larger than ordinarily in pregnancy at term, evenly 
nd fluctuating. Uterus normal. Diagnosis clearly indicated 
*t, probably unilocular. Ten days later, assisted by Dr. 
>f Batavia, her family physician, and others, I performed 
, removing a tumor weighing thirty -nine pounds. 
three inches long. No adhesions. Pedicle short, tied with 
r cut away with scissors, wound cauterized with Paqnelin's 
tery and pedicle dropped back. No fluid or blood escaped 
xlomen. The wound in the parietes was closed with silk- 
and no adhesive straps were applied between the stitches as 
inen rags saturated with equal parte of Calendula, Glycerine, 
iter were placed on the incision, with a pad of raw cotton 
ied by a flannel binder. 

k followed the operation worth noting, and Aconite was 
e slept three hours during the afternoon, and at ten o'clock 
sning she expressed herself as feeling very comfortably. 
jmperature was 109J. She slept seven hours during the 
it six o'clock the next morning the pulse was 80, tempera- 
;spiration 24. From this time on the patient was practically 
ver. The wound healed by the first intention, under the 
ily dressing, with not as much disturbance as often arises 
iinary cold. 

Miss S. L., Rochester, unmarried, 35 years of age, 
>ne year noticed abdominal enlargement. An ovarian 
diagnosed and tapped by her attending physician. Nothing 
i developed up to this time ; but soon after, the tumor 

she suffered much pain. It was not of a sharp, lancinat- 


ing character ; there was no characteristic discoloration of the skin, or 
any other symptom which especially indicated cancerous degeneration. 
She had occasional chills and fever. At the time of the operation, 
July, 1885, her pulse was 135 and temperature 102£. On careful 
examination it was thought that there was suppuration of the cyst, 
and that its prompt removal might possibly save the life of the patient- 
An eminent allopathic surgeon who saw her two days before the ovari- 
otomy concurred in this opinion. Her parents were not slow to under- 
stand the significance of her condition, and were anxious to take the last 
chance to save her. She was placed on the table in a moribund state, 
and my experienced anaesthetic assistant thought more than once that 
be would not be able to sustain life until the operation could be 

On dividing the structures of the abdomen the knife came down 
upon diseased adipose tissue, which indicated something more serious 
than mere suppuration of the sack. I halted here a" moment and my 
colleagues advised me to go forward with the operation, as it could 
only shorten her life for a few hours at the most In another moment 
we opened into an ascitic cavity, which discharged a bloody fluid, and, 
towards the last, much pus. The thickened peritoneum was now 
divided, and the tumor found adherent to the parietes. The adhesions 
were broken up by the fingers or enucleated, and the cyst was tapped 
and removed. The cancerous degeneration was wide spread in the 
abdomen, and the pelvic cavity contained a quart or more of pus. The 
wound was closed with wire, properly dressed, and the patient placed 
in bed ; she died twenty-three hours after. We felt quite satisfied 
that she did not die on the table. 

Case V. Mrs. L. Q., of Rochester, aged 45 years ; multilocular 
cyst, five years growing. During the last two years had been tapped five 
times. The sack was eighteen months in filling the first time, but the 
frequent use of the trocar during the last six months had exhausted her 
strength and reduced her almost to a skeleton. Towards the last she was 
confined to the bed and her sufferings were intensified by large bed 
sores over the spinous processes of three of the dorsal vertebrae, also 
over a portion of the sacrum. In this latter situation the bone was 
bare. She had declared that she would die before she would submit 
to an operation, but as her time grew rapidly near she changed her 
mind, and said she would have the tumor removed even if there was 
only one chance in an hundred to save her life. Her anguish was now 
so great that she preferred death to life, and requested me to complete 
the operation even though she died on the table. 


Bureau of Subgbby. 

Last December, assisted by Drs. White, Bissell, C. R. Sumner and 
H. M. Dayfoot, I performed ovariotomy while her pulse was 130, tem- 
perature 103, bowels actually inflamed and sack of tumor undergoing 
suppurative degeneration. The abdominal walls were only one-quarter 
of an inch thick, and the tumor was adherent. The less firm adhesions 
were divided by the fingers ; others were enucleated or tied in two places 
and cut between the ligatures. The omentum was badly diseased ; 
one-half of it was gathered up, tied with silk and removed. The 
pedicle was secured by ligature and cautery and the abdomen was 
rinsed with simple warm water until it came away clear ; the wound 
was closed with silk, and the patient placed in bed. The next morn- 
ing the temperature had fallen to 100 and she seemed much improved. 
An abscess formed in the excised omentum and discharged through the 
upper end of the nine inch wound, from which, five weeks later, I 
extracted the piece of silk placed around the diseased omentum. She 
recovered perfectly and remains well. The tumor weighed fifty-two 
pounds, and Dr. White, who removed her from the table after the 
operation, estimated that she would not weigh over sixty-five or sev- 
enty pounds. 

Strict homoeopathic prescribing was adhered to throughout, which* 
with perfect cleanliness, and Calendula dressings, was relied upon. 

It will be noticed that there are no symptoms in Case IV which 
direct especial attention to cancerous degeneration. Indeed, it was 
impossible to determine the pathological condition without the explor- 
atory incision. This is also true of Case V ; although the recovery 
of this patient was scarcely hoped for, ovariotomy proved successful 
even at the eleventh hour. 

The case with the cancerous degeneration cannot reasonably count 
against the per cent, of recoveries. 


jHomoeopatbic /T^efcical Society 

State of New York 





Rochester Democrat and Chronicle Print. 




Proceedings of the Thirty- Sixth Semi- Annual Meeting, held at Lyric Hall, 
New York City, on the 20th and 2xit of September, 1887. 

The meeting was called to order by President, H. M. Paine, M. D., 
of Albany. Prayer was offered by Db. A. S. Ball, of New York. 

Drs. A. B. Norton and T. M. Strong were appointed a Committee 
on Credentials. 

The Committee on Credentials subsequently reported the following 
members, delegates and visitors present : 

Drs. H. M. Paine, George E. Gorham, Albany, Albany Co. ; 
S. J. Fulton, Norwich, Chenango Co. ; Buren, Bethany, Columbia 
Co.; C. P. Cook, Hudson, Columbia Co.; P. A. Banker, Rhinebeck, 
Duchess Co.; L. A. Bull, Buffalo, Erie Co.; Susan S. McKinney, 
Samuel Talmage, Gertrude G. Bishop, Wm. E. McCune, John L. 
Moffat, Everitt Hasbrouck, E. Chapin, Wm. M. Butler, H. D. Schenck, 
Wm. C. Latimer, Alice B. Campbell, Alton G. Warner, E. J. Wall, 
S. Catherine Martineau, H. O. Rockefeller, Max G. Hein, W. B. 
Winchell, A. von der Liihe, R. C. Moffat, Brooklyn, Kings Co.; Robert 
Boocock, Flatbush, Kings Co.; J. M. Lee, Herbert M. Dayfoot, Roch- 
ester, Monroe Co. ; I. G. Baldwin, A. S. Ball, H. I. Ostrom, M. W. 
Palmer, A. W. Palmer, J. W. Dowling, T. Franklin Smith, St. Clair 
Smith, Henry M. Smith, Robert McMurray, W. H. King, Lewis Hal- 
lock, J. M. Schley, George G. Shelton, C. W. Cornell, George M. Dil- 
low, E. J. Pratt, Malcom Leal, Clarence E. Beebe, Chas. C. Boyle, 
F. H. Boynton, Sidney F. Wilcox, Edwin West, F. M. Dearborn, S. H 
Vehslage, A. Berghaus, N. A. Mossman, Walter H. Jones, George S. 
Norton, John H. Thompson, A. B. Norton, D. B. Hunt, H. M. Dan. 
forth, M. A. Brinkman, T. F. Allen, Egbert Guernsey, Henry C. 
Houghton, Fred S. Fulton, A. M. Woodward, W. S. Miner, J. F. Land, 




4 Proceedings. 

Louis A. Queen, Clarence C. Howard, Virgil Thompson, E. D. Frank- 
lin, J. S. Cummins, F. M. Cummins, Chas. E. Teets, George W. 
McDowell, Wm. H. Scott, H. Worthington Paige, Sarah N. Smith, 
ii-'r. "W". S. Pearsall, B. J. Burnett, John J. Russell, J. B. Garrison, R. E. 
Hinman, Arthur F. Eife, B. G. Carleton, G. T. Hawley, S. H. Knight, 
E. Guernsey Rankin, C. Eurich, F. W. Hamlin, L. Lannin, Chas. 
Deady, Amelia Bassett, New York, New York Co.; T. M. Strong^ 
W. N. Reynolds, C. E. Chase, W. T. Helmuth, Jr., Martin Deschere, 
Chas. McDowell, F. H. Monroe, Wards Island, New York Co.; M. O. 
Terry, Utica, Oneida Co.; Selden H. Talcott, Edwin Fancher, Middle- 
town, J. W. Ostrom, Goshen, Orange Co.; C. A. Beldin, Jamaica, 
Queens Co.; E. L. Crandall, E. S. Coburn, Troy, Rensselaer Co.; 
M. W. Van Denburg, Fort Edward, Washington Co. ; G. D. Dresser, 
Shrub Oak, E. P. Swift, Pleasantville, Westchester Co.; James 
Hoffman, S. Wellman Clark, Jersey City, N. J.; C. W. Butler, 
Montclair, N. J. ; Sarah C. Spottiswood, Orange, N. J. ; Harriet L. 
Knudsen, Newark, N. J.; Sayer Hasbrouck, Providence, R. I.; 
E. H. Linnell, Norwich, Conn.; F. B. Kellogg, New Haven, Conn. 

Communications from Drs. Helmuth and Dowling were received 
explaining their absence from the meeting. A communication from 
Alfred K. Hills, M, D., Secretary of the Medical Board of the 
Homoeopathic Hospital at Ward's Island, tendering every courtesy to 
the Society and extending an invitation to visit the Island. 

Dr. Strong was appointed a Committee to carry out the wishes of 
the Society in accepting the invitation. 

On motion, a Committee consisting of Drs. Lee, Houghton and Bull 
was appointed to take suitable action regarding the Semi-Centennial 
Meeting at Pittsburgh. 

The Committe subsequently reported the following telegram, which 
was adopted and ordered sent : 

The Homoeopathic Medical Society of the State of New York ex- 
presses fraternal sentiments and tenders its congratulatory greetings to 
the Homoeopathic Medical Society of Pennsylvania on the occasion of 
the fiftieth anniversary of the introduction of homoeopathy into the 
city of Pittsburgh. 

The President, Horace M. Paine, M. D., then delivered the follow- 
ing address. 

Gentlemen of the Society : 

It becomes my pleasant task to announce that the hour has arrived 
*or the beginning of the sessions to be held in connection with the 


Thirty-Sixth Semi- Annual Meeting. 5 

thirty-sixth Semi- Annual Convocation of this Society, and to declare 
that the meeting is open for business. 

In connection with the exercise of this official prerogative, I may be 
permitted, briefly at least, to grapple with Father Time, and compel 
him to retrace his hurried steps, in order that we may rescue from ob- 
livion a few of the items of personal history which he, in his impetuous 
forward career, is steadily endeavoring to cover with the cobwebs of 
the ages. 

I well remember attending the first meeting of this Society, and 
some of the incidents connected therewith. The records state that : 

"In accordance with previous notice, a number of homoeopathic 
physicians, from different parts of the State of New York, assembled 
in the Common Council room of the city hall, in the City of Albany, 
at ten o'clock in the forenoon of May 15th, 1850, for the purpose of 
devising such measures as the condition and interests of homoeopathy 
in this State should render expedient." 

I think there were about twenty physicians present. Prominent 
among the names of these worthies are those of Drs. John F. Gray, 
I. M. Ward, S. R. Kirby, Jacob Beakley, Henry D. Paine, E. D. Jones, 
J. W. Metcalf, E. S. Byran, A. S. Ball and Alonzo Hall. 

Of these, as far as I and able to ascertain, only five or six remain. 
These are Drs I. M. Ward, H. D. Paine, E. D. Jones, A. S. Ball and 
H. M. Paine. 

At the first meeting, on proceeding to an election of officers, a spon- 
taneous eruption of personal fellowship was strikingly brought out in the 
election of Dr. I. M. Ward to the presidency. There had been no 
previous canvassing. There were no apparent motives for the selec- 
tion of one candidate in preference to another, other than the strength 
of personal friendship. 

Dr. Ward had resided in Albany seven years. A few months prior 
to the meeting he had removed to New Jersey, and for that reason his 
eligibility was questioned. He was almost unanimously elected, how- 
ever, on the ground that it was his intention to spend two months each 
summer at Saratoga. 

Dr. Ward's election was unquestionably owing to his suavity, agree- 
able manners, and an intimate personal acquaintance with all the mem- 
bers who were present. 

Dr. Kitby was the talker for the whole school. He could talk 
against time on any subject connected with medicine that might be 
brought up,. His great, un wieldly body; his portly bearing; his 

J . f * V ' J j*i <• 

!■* V 

6 Proceedings. 

astonishing mobility of countenance ; his peculiar lisp ; bis earnestness 
of manner when interested in any subject under discussion, combined 
Sf to constitute a character and person the like of whom has not since 
been seen in our midst 

Dr. J. F. Gray, it seems to me, ought to bave been honored by the 
presidency. He had even then attained eminence in his profession. 
His great learning ; his recognized skill as a diagnostician ; his frequent 
contributions to the medical literature of the day, ought not, it would 
seem, even at that early day, to have been overlooked. Twenty-one 
years afterward, however, his profound erudition and great ability 
were duly recognized by the Society by his election to the presidency, 
the nineteenth on the list. 

I became intimately acquainted with Dr. Gray during the latter years 
of bis life, and learned to admire his good qualities and to have great 
respect for his opinions and wishes regarding many of the practical 
medical questions of the day. 

Dr. Metcalf would, had he lived longer, have become one of the 
shining lights in our school. He possessed a clear, logical mind. His 
writings have enriched our materia medica. His quiet, reserved man- 
ner, and his forcible and timely utterances, are still deeply impressed 
on my memory. 

Dr. Ball, whose flowing locks are whitened by more than four score 
and eight winters, is still here with us. His venerable and stately form 
has been seldom seen at the meetings of the Society. His life work 
has been that of a faithful adherent to homoeopathic principles, and an 
honest endeavor to apply them in the treatment of disease. 

The last of these founders of the Society whose name I will mention 
in these brief notes is that of the versatile Beakley. 

I do not think that Professor Beakley was present at the first meet- 
ing; he was, however, a frequent attendant at the sessions of the 
Society subsequently. He always related interesting cases, and was 
always a great stickler for a strict observance of parliamentary rules. 

At the first meeting of the Society he was appointed chairman of a 
committee to prepare an address to the homoeopathic physicians of the 
State "urging united and harmonious action." Thus early, at the very 
beginning of the organization, his tact and fostering services were made 
instrumental in laying the foundation of permanence, development and 
substantial progress, by which we, his survivors, have been profited, 
and have richly enjoyed. 

But how does it happen that at the very start, thirty-seven years 

o, effort was needed to secure the desirable qualities represented by 

Thibty-Sixth Semi Annual Meeting. 7 

unity of sentiment and harmony of action ? One would suppose that, 
having kindred purposes and interests, the homoeopathists, of whom at 
that time there were about two hundred in the State, would instinct- 
ively coalesce, and that no special effort for promoting unity and har- 
mony would be required. 

These essential qualities were needed at the inception of this organi- 
zation, in order the better to maintain a defensive position against an 
opposing school and system ; and from that time to the present the 
reasons for putting forth effort with a view of promoting unity and 
harmony among homoeopathists, have been just as cogent and forcible 
as they ever were. 

Organized opposition to homoeopathic truth, although of late years, 
from motives of policy, is less pronounced, covertly is as earnest and 
active as any time in the history of this Society. 

What these reasons are ; why we allow ourselves to be recognized 
by a distinctive name ; why we are continually planning to maintain 
our distinct organizations, to develop our resources, and make more 
rapid advances in future, I must make the subject of an address at the 
next annual meeting. Suffice it for the present to say, that so long as 
the dominant school refuses to accept the homoeopathic principle as 
the leading one in the domain of therapeutics, and places us and our 
school under a ban because we hold such a tenet, and so long as non- 
homoeopathists refuse to teach their own students the benign truths of 
homoeopathy, it is incumbent upon us to hold our position, to maintain 
a separate organized existence, and above all to retain the distinctive 
name; for, if we give up our name, who, and what, and where are we ? 

The distinctive name is our birthright ; it is ours by inheritance ; it 
is ours by conquest ; it is ours, and ever will be ours, in spite of our- 
selves, so long as homoepathy is known as a recognized method of cure. 

Gentlemen, the meeting is now open for the transaction of business. 

The address was referred to a committee consisting of Dbs. A. B. 
Nobton, Gobham and Dillow. 

(For paper and discussion see hv/reau report.) 

The Pbesident called for the report of the Bureau of Materia 
Medica, E. H. Wolcott, M. D., Chairman. 

Db. Woloott being absent, Db. VanDenbubg presented the bureau 

8 Proceedings. 


L. A. Bull, M. D., Chairman. (For papers and discussions see 
bureau report.) 

The Society adjourned until 3 p. m. 


On motion the courtesy of the Society was extended to 0. W. But- 
ler, M. D., President of the New Jersey State Homoeopathic Medical 
Society; E. H. Linnell, M. D., President of Horn. Med. Society of 
State of Connecticut, and all visiting physicians. 

The following telegram was received and read : 

Pittsburgh, Pa., Sept. 20, 1887. 

To Dr. H. M. Dayfoot, Secfy New York State Horn. Med. Soc. : 

The Homoeopathic Medical Society assembled at Pittsburgh send 
greeting to the Homoeopathic Medical Society of the State of New 

(Signed), A. R. Thomas, M. D., President. 

Clarence Butler, M. 1)., Secretary. 

The committee on President's Address reported the following reso- 
lution, which was adopted : 

Resolved, That as long as the dominant school of medicine refuses 
to accept the homoeopathic principle as the leading one in the domain 
of therapeutics, and places homoeopathic physicians and the homoe- 
opathic school under a ban ; and so long as non-homoeopathists ref ase 
to teach their own students the benign truths of homoeopathy, it is 
incumbent upon the homoeopathic school to hold its position, to main- 
tain its separate organizations, and to retain its distinctive name. 

The Committee on Medical Legislation reported the following : 

Mr. President; 

The Committee on Medical Legislation have the honor and pleasure 
to report that the Bill, substantially as introduced last year, entitled "An 
Act to regulate the licensing and registration of physicians and sur- 
geons, and to codify the medical laws of the State of New York," has 
become a law. 

Thirty-Sixth Semi-Annual Meeting. 9 

It had a perilous passage from the time it was introduced into the 
Assembly early in the session, nntil it received the Governor's signa- 
ture late in June. Irregular practitioners and some members of the 
eclectic school assailed it with a surprising amount of ignorance and 
oratory. Your committee appeared before the committee on public 
health time after time during the winter, to show the merits of the 
bill and listen to doctors, lawyers and laymen in their attempts to 
defeat it. 

The committee feel greatly indebted to Dr. Bendell, of Albany, 
Chairman of the Committee of Medical Legislation for the Medical 
Societv of the State of New York, for his able and efficient labors in 
behalf of the Bill. To him and the attorney employed by his commit- 
tee, Mr. Purrington, and our own indefatigable Dr. Paine, we are 
indebted for the passage of the Bill ; and I would ask that the thanks 
of this Society be tendered these gentlemen. 

I herewith hand you a certified copy of the law. 

Geo. E. Gobham, Jno. J. Mitchell, 

H. M. Paine, Hebbert M. Dayfoot, 

Lester M. Pratt, A. E. Wright, 

Selden H. Talcott, E. M. Kellogg, 

Everitt Hasbrouck, Edward S. Coburn, 
Asa S. Couch, Committee. 

LAWS OF NEW YORK.— By Authority. 

[Every law, unless a different time shall be prescribed therein, shall com- 
mence and take effect throughout the State, on and not before the twentieth 
day after the day of its final passage, as certified by the Secretary of State. 
Sec. 12, title 4, chap. 7, part 1, Revised Statutes.] 

Chap. 647. 

AN ACT to regulate the licensing and registration of physicians and 

surgeons, and to codify the medical law6 of the State of New York. 

Passed June 23, 1887 ; three fifths being present. 

The People of the State of New York, represented in Senate and 
Assemhlg, do enact as follows : 

Section 1 . No person shall practice physic or surgery in this State 
who shall not have attained the age of twenty-one years ; and no per- 
son shall practice as aforesaid unless he or she shall be, at the time this 
act shall take effect, a person lawfully engaged in such practice in this 
State under license or authority conferred by its laws then in force, and 
lawfully registered pursuant to chapter five hundred and thirteen of 

10 .Proceedings. 

the laws of eighteen hundred and eighty, and the acts amendatory 
thereof, or unless he or she shall be licensed or authorized so to prac- 
tice by the provisions of this act, and registered as herein prescribed. 

§ 2. From and after the date of the taking effect of this act, no per- 
son not theretofore licensed or authorized to practice physic or surgery 
in this State shall be deemed so licensed or authorized except one of 
the three following classes : 

First. All who shall have been graduated from an incorporated med- 
ical school or college in this State with the degree of doctor of medi- 
cine, after substantial compliance with all the requirements of the 
general laws and of the charter of said corporation regulating the term 
and amount of study, attendance and attainment requisite to obtain 
said degree ; provided that no person shall receive the degree of doctor 
of medicine, or be licenced to practice physic or surgery in this State, 
unless after the age of eighteen he shall have pursued the study of 
medical science for at least three years in a chartered medicaj school 
or with aome physician and surgeon duly authorized by law to practice 
physic or surgery ; and shall have attended two complete courses of 
lectures in some legally incorporated medical school or college, in good 
standing at the time of such attendance, prior to the granting to him 
or her a diploma or license ; provided, further, that two courses of lec- 
tures, both of which shall be either begun or completed within the 
same calendar year, shall not satisfy the above requirement. 

Second. All who have received said degree from the Regents of the 
University of the State of New York after substantial compliance with 
the legal requisites preliminary to its attainment, and after examination 
by a legally constituted board of medical examiners of this State. 

Third. All who, having been graduated from incorporated medical 
schools or colleges without the State as doctors of medicine, or licensed 
to practice physic or surgery under the laws of those European coun- 
tries in which said degree does not confer the right so to practice, shall 
procure their diplomas from said corporations, or their licenses from 
such countries, to be indorsed by the faculty of an incorporated medical 
school or college within this State, or by the Regents of the University 
on the recommendation of a legally constituted board of medical exam- 
iners of this State. Every such indorsement shall be in form of sched- 
ule A or of schedule B provided by the tenth section of this act. Every 
corporation or board so indorsing, shall keep a record of their indorse- 
ments, and may require applicants to verify their statements under 
oath ; any indorsement made with fraudulent intent, or gross careless- 

' * m 

Thibty-Sixth Semi- Annual Meeting. 11 

Hess or ignorance, shall be deemed a misdemeanor and shall subject 
the indorser or indorsers, upon conviction thereof, to a fine of two 
hundred and fifty dollars. 

§ 3. Every person who, at the time this act shall take effect, shall be 
practicing lawfully physic or surgery in this State, under the authority 
and license conferred by the laws then in force, but who shall not be 
then duly registered in the county where he or she practices ; and 
every person who shall thereafter become lawfully authorized or licensed 
to practice physic or surgery in this State, shall register in a bock to be 
kept in the clerk's office of the county in which such practice is carried 
on, his or her name, residence, place and date of birth, and authority 
for practicing as aforesaid. Every person who shall apply to register 
as a physician or surgeon shall be required, before registration, to sub- 
scribe and verify by oath or affirmation, before a person qualified to ad- 
minister oaths in this State, an affidavit which shall be filed and pre- 
served in a bound volume. This affidavit shall be in the form prescribed 
in schedule C, provided by the tenth section of this act. Every person 
registering as aforesaid shall exhibit to the county clerk his or her 
diploma or license, or in case of loss, a copy of either, legally certified as 
are copies of documents admitted in evidence, or a duly attested tran- 
script of the record of its conferment from the body conferring it, upon 
which the said clerk shall indorse, or stamp his name, and the words 
" Presented and registered as authority to practice physic and 

surgery by , on the day of , in the clerk's office 

of county." The said clerk shall also give to every registered 

physician or surgeon a certificate in the form of schedule D, provided 
by the tenth section of this act. For all of his said services the county 
clerk shall receive as a total fee for registration, affidavit and certificate 
the sum of one dollar. It is provided, however, that nothing in this 
act shall require- any physician or 6urgeon who shall have duly regis- 
tered lawful authority to practice as such, conformably to the provisions 
of chapter five hundred and thirteen of the laws of eighteen hundred 
and eighty, and the acts amendatory thereof, to register again under 
the provisions of this act, in any county where he or she shall have 
registered already. 

§ 4. A practicing physician or surgeon having registered lawful 
authority to practice physic or surgery in one county, who shall remove 
his practice or part thereof to or regularly engage in practice or open 
an office in another county, shall exhibit in person to the clerk of such 
other county, or shall send to him through the mail by registered letter, 

12 Proceedings. 

his certificate of registration, and if such certificate shows lawful 
authority to have been registered said clerk thereupon shall register 
said applicant in said latter county, on receipt of a fee of twenty-five 
cents. The clerk shall stamp or indorse upon such certificate the words 
" Registered also in county," and return the same and every cer- 

tificate and indorsement made pursuant to the provisions of this act 
shall be prima facie evidence in any legal proceeding that the person 
named has registered in the office issuing the same, the authority stated 
in the transcript. 

§ 5. Every person now licensed to practice physic or surgery in this 
State under the laws thereof in force at the time of the conferment of 
such license, unless he or she already shall have registered his or her 
name, residence, place of birth and authority so to practice pursuant to 
the provisions of section two of chapter five hundred and thirteen of 
the laws ofc eighteen hundred and eighty, and the acts amendatory 
thereof, shall comply with the requirements of said chapter on or be- 
fore the first day of October, eighteen hundred and eighty-seven ; and 
thereafter no person shall be entitled to register any authority to prac- 
tice physic or surgery, except the license conferred under this act, and 
the laws enacted hereafter, and no registration shall be considered 
valid as such unless the authority registered constituted at the time of 
registration a license under the laws of this State then in force; pro- 
vided that nothing in this section shall be construed to prohibit or sus- 
pend any prosecution for non-registration under said section instituted 
prior to said first day of October, eighteen hundred and eighty-seven 
and further provided, that no diploma or license conferred upon a 
person not actually in attendance at the lectures, instruction and 
examination of the corporation conferring the same, or not possessed at 
the time of its conferment of the requirements then demanded of med- 
ical students in this State as a condition of their becoming licensed so 
to practice, shall be deemed lawful authority to practice physic and 
surgery in this State. 

§ 6. No person shall be licensed or permitted to practice physic or 
surgery in this State who has been convicted of a felony by any court 
of competent jurisdiction ; and if any person who is or hereafter shall 
be duly licensed to practice physic or surgery in this State, shall be 
convicted of a felony, as aforesaid, his or her license to so practice, if 
any, shall be revoked by the fact of such conviction having been had. 
Any person who shall willfully swear falsely to any statement con- 
tained in any affidavit made pursuant to the provisions of this act shall 

Thirty-Sixth Semi-Annual Meeting. 13 


be deemed guilty of a felony, and subject to conviction and punish- 
ment for perjury ; any person who falsely and without authority shall 
counterfeit, make or alter any diploma, certificate or instrument con- 
stituting a license to practice physic or surgery within this State, or 
any certificate or indorsement given in pursuance of this act shall be 
deemed guilty of a felony, and be subject to conviction and punishment 
for forgery in the second degree ; any person who shall practice physic 
or surgery under a false or assumed name, or who shall falesly person- 
ate another practicioner of a like or different name, shall be deemed 
guilty of a felony, and shall be subject to conviction and punishment 
for false personation; and any person guilty of violating any of the 
other provisions of this act, not otherwise specifically punished herein, 
or who shall buy, sell or fraudulently obtain any medical diploma, 
license, record or registration, or who shall aid or abet such buying, 
selling pr fraudulently obtaining thereof, or who shall practice physic 
or surgery in this State under cover of a diploma or license that shall 
have been illegally obtained, or that shall have been signed or issued 
unlawfully or under fraudulent representations, or mistake of fact in 
material regard, or who, after conviction of a felony as aforesaid, shall 
attempt to practice physic or surgery in this State, and any person 
who shall assume the title of doctor of medicine, or append the letters 
" M. D." to his or her name, without having received the degree of 
doctor of medicine from some school, college or board empowered by 
law to confer said degree or title, shall be deemed guilty of a misde- 
meanor, and upon conviction thereof shall be punished by a fine of not 
less than two hundred and fifty dollars, or imprisonment for six months 
for the first offense, and upon conviction of a subsequent offense, by a 
fine of not less than five hundred dollars or imprisonment for not less 
than one year, or by both fine and imprisonment. Any person who, 
not being then lawfully authorized to practice physic or surgery in this 
State and so registered according to law, shall practice on or after the 
first day of October, eighteen hundred and eighty-seven, physic or 
surgery within this State without the license and registration provided 
for in this act, shall be deemed guilty of a misdemeanor, and on con- 
viction thereof shall be punished by a fine of not less than fifty dollars 
for the first offense, and for each subsequent offense by a fine of not 
less than one hundred dollars, or by imprisonment for not less than 
one hundred days, or by both fine and imprisonment. When any 
prosecution under this act is made on the complaint of a lawfully 
incorporated medical society of this State, or a county society entitled 
to representation in a State society or association, the fines when collected 

14 Proceedings. 

shall be paid to the society making the complaint, ^nd any excess of 
the amount of fines so paid over the expense incurred by the said 
society in enforcing the medical law of this State, shall be paid at the 
end of the year to the county treasurer, for the use of the poor of said 

§ 7. The duly incorporated medical societies of any county in which 
any person shall practice physic or surgery without lawful authority 
or registration may, upon proof of such practice, recover from such 
practitioner, in an action before any justice of the peace, a penalty of 
twenty-five dollars and the cost of the action for the first judgment, 
and upon every subsequent judgment for the same offense a penalty 
of fifty dollars and the cost of the action ; provided that said societies 
shall pay to the county treasurer for the use of the poor of said 
county any surplus that may accrue in their hands from the excess of 
fines and penalties collected over the disbursements of said society for 
counsel fees and the expenses incident to the enforcement of this act 
by them. 

§ 8. Nothing in this act shall be construed to punish commissioned 
medical officers serving in the army or navy of the United States, or in 
the United States marine hospital service, while so commissioned, or any 
one while actually serving as a member of the resident medical staff 
of any legally incorporated hospital, or any legally qualified and reg- 
istered dentist exclusively engaged in practicing the art of dentistry, 
or interfere with manufacturers of artificial eyes, limbs or orthopedical 
instruments or trusses of any kind from fitting such instruments on 
persons in need thereof; or any lawfully qualified physicians and sur- 
geons residing in other States or countries meeting registered physicians 
and surgeons of this State in consultation, or any physician or surgeon 
residing on the border of a neighboring State, and duly authorized 
under the laws thereof to practice physic or surgery therein, whose 
practice extends into the limits of this State ; providing that such prac- 
titioner shall not open an office or appoint a place to meet patients or 
receive calls within the limits of the State of New York ; or physicians 
duly registered in one county of this State, called to attend isolated 
cases in another county, but not residing or habitually practicing 

§ 9. The following acts and parts of acts are hereby expressly 
repealed, to wit : Sections eight to twenty-two inclusive of title seven 
of chapter fourteen of part one of the Revised Statutes ; also all of 
chapter one hundred and thirty-eight of the laws of eighteen hundred 

Thirty-Sixth Semi-Annual Meeting. 15 

and six, that provided for the examination and admission of medical 
students to practice, and for penalties for practicing physic and sur- 
gery without a diploma or other lawful authority ; also section or para- 
graph fifth of chapter one hundred and four of the laws of eighteen 
hundred and seven ; also sections nine, ten, eighteen and all of section 
eleven following and including the words "whose duty" of chapter 
ninety-four of the laws of eighteen hundred and thirteen ; also sections 
one, two, four, and all of section three following and including the 
words "any three" of chapter two hundred and six of the laws of 
eighteen hundred and eighteen ; also section two of chapter two 
hundred and thirty-seven of the laws of eighteen hundred and nineteen ; 
also chapter one hundred and twenty -six of the laws of eighteen hun- 
dred and thirty; also sections one, two and four of chapter five hun- 
dred and thirty-two of the laws of eighteen hundred and thirty-six; 
also chapter sixty-four of the laws of eighteen hundred and forty -one ; 
also chapter two-hundred and seventy-five of the laws of eighteen hun- 
dred and forty-four ; also chapter four hundred and thirty-six of the 
laws of eighteen hundred and seventy-four ; also chapter five hundred 
and thirteen of the laws of eighteen hundred and eighty ; also chapter 
one hundred and eighty-six of the laws of eighteen hundred and eighty 
one; also chapters four hundred and eleven and four hundred and 
forty-five of the laws of eighteen hundred and eighty-four ; also sec- 
tion three hundred and fifty-six of the Penal Code. And also all acts 
or parts of acts authorizing any incorporated school or college to con- 
fer the degree of doctor of medicine causa honoris or ad eundem^ or 
otherwise, than upon duly graduated students in course : and all other 
acts or parts of acts inconsistent with this act are hereby repealed. And 
it is provided that the degree of doctor of medicine conferred causa 
honoris or ad eundem gradum, shall not be a qualification for the prac- 
tice of physic and surgery in this State. And, whereas it is the pur- 
pose of this act to codify the statutory provisions of this State regu- 
lating the admission of individuals to the practice of physic and sur- 
gery, and the punishment of those practicing either physic or surgery 
without authority. It is further provided that tjie specific repeal herein 
of any portion of an act that may have been heretofore repealed, 
expressly or by implication, shall net be construed to revive the remain- 
ing part thereof. 

§ 10. Section ten shall embrace the following schedules, namely A, 
B, C and D. 


• •; 1 .. 

;. s 
i • 

> i 





T<? #W whom it may concern, greeting : 

A. B., having on the day of eighteen hundred and , pre- 
sented to the faculty of , a diploma purporting to have been issued 
on the day of , to said A. B., conferring on the degree of doc- 
tor of medicine, and it being made certain to us by inquiry and 
examination, that the said , at the date of said diploma, was a 
medical college or school, duly incorporated, in good standing and 
authorized to confer the degree of doctor of medicine, and also that 
the said A. B. is the identical person upon whom the said diploma 
was conferred, and is also a person of good moral character, who has 
pursued a course of study equivalent to that required of a doctor of 
medicine by said faculty, and is sufficiently well versed in the knowl- 
edge of physic and surgery to qualify to practice the same. 

Now, therefore, the said faculty have caused this indorsement and 
the seal of the said to be placed upon said diploma. 

(Signed) by the dean or proper officer. 
~ [seal] 


To all whom it may concern, greeting : 

A. B., having on the day of presented to the faculty of 
a license purporting to have been issued to said , as authority to 

practice physic and surgery in all branches ; and it being made certain 
to us by inquiry and examination that A. B. is the identical person on 
whom the license was conferred ; that it is not necessary in the country 
in which it was conferred, that a licensed practioner of physic and 
surgery should have the degree of doctor of medicine, and that a 
license in form and substance such as the one hereby indorsed is the 
usual and sufficient authority to practice physic or surgery therein ; 
and further, that said A. B. is a person of good moral character, who 
has pursued a course of study equivalent to that required of a doctor 
of medicine by our faculty, and is sufficiently versed in the knowledge 
of physic and surgery to practice the same. 

Now, therefore, the said faculty have caused this indorsement and 
the seal of the said to be placed upon said license. 

(Signed) by the dean or proper officer. 


Thirty-Sixth Semi-Annual Meeting. 17 


State of New York, ) 
County of f 88 ' ' 

being duly sworn says that h name is ; that 

was born in on the day of , in the year ; that now 

resides at number street, in the city of , and intends to 

practice physic and surgery in the county of ; that h authority 

so to practice is a license (or diploma), conferred upon h , on the 

day of ,, in the year , by , a duly incorporated medical , 
school (or college), or a legally constituted board of medical examiners 
of the State of New York, authorized at the date of conferring said 

to confer the same, and being then in good standing ; (or in case 
of a European license, describe the source thereof, and the authority 
under which it was conferred). Affiant further says that is 

the person named in the said , and had, before receiving the same, 
fully and substantially complied with the requisities as to attendance, . 
terms and amount of study and examinations required by the laws of 
the State and the charter and regulations of said as preliminary 
and necessary to the conferment thereof. Affiant further says that no 
money was paid by for said except the regular fees paid by 

all applicants therefor ; that no fraud, misrepresentation or mistake in 
any material regard was employed by any one, or occurred, in order 
that said should be conferred on affiant. (Where indorsement has 
been made a license or diploma granted without the State, this addi- 
tional clause shall be verified.) 

And affiant further says that the said diploma or license was indorsed 
on the day , eighteen hundred and , by the faculty of , 
upon satisfactory proof by affiant of all the facts hereinabove recited, 
and that had followed a course of study equivalent to the curriculum 
of said , and was competent to practice physic and surgery. 

Sworn to before me, this ) 
day of J 



To whom, it may concern : Know ye, that on the day of 

A. JB., having first subscribed and verified an affidavit in the form of 
schedule C of chapter of the laws of eighteen hundred and eighty 

seven, made an entry in the register of physicians and surgeons, kept 



in the office of the clerk of county, of which entry I certify the 
following to be a transcript : 




Date, source and 

character of 

license or diploma. 

Indorsed by 
what FACULTY. 


In witness whereof I have set my hand and official seal this 
day of 

Clerk of county. 


§ 11. This act shall take effect immediately. 

State of New York, } 

Office of the Secretary of State, ) s ' ' 

1 have compared the preceding with the original law on file in this office, 

and do hereby certify that the same is a correct transcript therefrom and of 

the whole of said original law. 


Secretary of State. 

On motion of Dr. Moffat, the thanks of the Society were tendered 
to Drs. Paine, Bendell and Mb. Purrington for their able and effi- 
cient labors in behalf of the Bill. 



A. B. Norton, M. D., Chairman. {For papers and discussion see 
bureau report.) 


Charles E. Jones, M. D., Chairman. {For papers see bureau 

H. L. Waldo, M. D., Chairman. {For papers see bureau report) 


Thibty-Sixth Semi- Annual Meeting. 19 


Dr. Terry offered the following resolution, which was adopted : 

Resolved, That it is the sentiment of this meeting that the Executive 
Committee would be justified in permitting the publication of papers 
read at this meeting elsewhere than in the Transactions of the Society. 

W. C. Latimer, M. D., Chairman. (No papers.) 

A. E. Wright, M. D., Chairman. (No papers.) 


Edwin J. Pratt, M. D., Chairman. (For papers and discussion 
see bureau report?) 

Moved by Dr. Houghton, seconded by Dr. Strong, that a Com- 
mittee be appointed to take into consideration the financial condition 
of the Society and devise ways to improve its general condition. 


Referred to the present Executive Committee to report at Annual 

The Society then adjourned and partook of the hospitality of the 
New York County Homoe6pathic Medical Society in a most enjoyable 
collation, and listened to interesting addresses from Drs. Paine, R. C- 
Moffat, Ball and MoMurray. 

SECOND DAY— Wednesday. 

Meeting called to order at 11:45 a. m. Dr. Houghton offered the 
following resolution, which was adopted: 

Resolved, That it is the sense of this meeting that in order to be 
consistent in the publication of papers read at the sessions of this 
Society the Executive Committee be requested to consider the matter 
of publishing such papers as were rejected on account of the resolution 
at the last Annual Meeting. 

20 ' Proceedings. 


J. M. Lee, M. D., Chairman. {For papers and discussion see 
bureau report?) 


S. H. Talcott, M. D., Chairman. {For papers and discussion see 
bureau report ) 


Louis Faust, M. D., Chairman. {Jfo papers) 


Fred. S. Fulton, M., D., Chairman. {For papers see bureau report) 


Walter Y. Cowl, M. D., Chairman. {For papers see bureau re- 

The Secretary announced the following applications for membership: 

Drs. J. Oscoe Chase, F. H. Boynton, Clarence E. Beebe, B. Gar- 
rison, Charles McDowell, Arthur F. Eife, Eugene H. Porter, Stephen 
H. Knight, C. Eurich, George T. Hawley, Joseph F. Land, L. L. 
Danforth, Charles Deady, Alton G. Warner, Wm. T. Helmuth, jr., 
B. J. Burnett, Alexander Berghaus, Willliam H. Scott, Charles E. 
Teets, W. U. Reynolds, E. D. Franklin, Virgil Thompson, H. M. 
Dearborn, Edwin J. Pratt, New York City ; Edward P. Swift, Pleas- 

Dr. Everitt Hasbrouok : Reference to the records of this Society 
will show that our deceased member, Dr. Titus L. Brown, of Bing- \ 

hamton, ever had the interests of the Society largely at heart, and 
attended its meetings with a regularity almost unprecedented. In 
view of these features of our dead brother I move you that the Secre- 
tary be instructed to send to the family of Dr. Brown a minute of our 
special recognition of his worth as a colleague and member, and to 
spread a copy of the same on the records of the Society. 

Seconded and Carried. 

Thirty-Sixth Semi- Ann dal Meeting. 21 

The following resolution was offered by Dr. Boocock : 

Whereas, It is currently reported that Robert Boocock, a member 
of this Society has no legal standing as a practitioner of medicine ; 

Resolved, That the Committee of this Society for the Southern 
District be instructed to fully investigate the matter and report upon 
the same at the Annual Meeting. 


Moved and seconded that a vote of thanks be tendered the New 
York County Homoeopathic Medical Society and the Local Com- 
mittee of Arrangements for their generous hospitality. 


On motion the Society adjourned. 

22 Bureau of Materia Mediga. 




E. H. WoLooTT, M. D. Chairman, - - Rochester. 

Drs. F. F. Laird, Utica. 

C. D. Hale, Syracuse. 

M. A. Van Denburo, ... - Fort Edward. 

W. W. Seeley, - Albany. 

H. G. Preston, - - Brooklyn. 

John 0. Otis, .... . Poughkeepsie. 


By Edwin H. Woloott, M. D. 


As homoeopathists, this is a vital subject ; in fact, it may well be 
considered the central truth of our profession. There is no field of 
labor that promises so much, not only to us individually, but to the 
cause we represent, as the selection of the indicated remedy. We, 
ourselves, cannot expect to succeed, or contribute to the welfare of 
homoeopathy, unless the pathogenetic effect of the remedy chosen 
corresponds very nearly at least with the diseased condition. I 
admit that it is often difficult to decide whether or not a certain remedy 
is indicated, and that it frequently requires diligent and faithful study 
to make the selection. Yet when it is found, we are so certain to 
relieve, and perhaps effect a brilliant cure, that we do not for a moment 
regret the effort. The question of the indicated remedy, whether we are 
conscious of it or not, is ever before us. It requires our constant 
thought and attention; no one subject so continually occupies our 
mind, and nothing will so surely measure our success or decide our fail- 
ure in practice. 

* Semi- Annual Meeting 1886. 

Bureau of Materia Medica. 23 

We cannot afford to neglect or slight the corner-stone of homoeop- 
athy. We are also called upon to decide whether the indicated remedy 
is meant to include combinations, or medicines given alternately. 

This question has been so frequently presented, and received so 
much consideration, that I omit its discussion and produce, instead, a 
series of cases from my note book, showing the action of the indicated 
remedy, as a single remedy, in a variety of acute and chronic conditions. 

Case I. — Etta, aged four years ; for a long time a subject of chronic 
eczema affecting the external portions of the auditory canal and lobes 
of both ears, as well as the greater portion of the tissue covering the 
parietal and frontal bones. The ears were constantly discharging, the 
lobes were congested and swollen, there were deep ffssurcs behind the earp 
at their union with the adjacent integument and the parietal and frontal 
regions were covered with a scaly like substance. The inflammation had 
been sufficient to destroy the growth of hair and produce marked dis- 
figuration of the tissues involved. This condition of the child had 
been existing nearly two years, notwithstanding the treatment adminis- 
tered by several physicians. After having been under my care for 
about two months I gave Graph. 3x three times a day. In a week a 
marked improvement was apparent ; the remedy was continued for two 
or three weeks longer, when it was noticed that the child was getting 
deaf. After withholding the remedy for a week the hearing returned. 
I continued this treatment for some time, occasionally being obliged to 
discontinue the remedy for a short time on account of the deafness; 
meantime the disease gradually abating, not so marked, however, 
when the medicine was withheld as when it was administered. It was 
now plain to be seen that this remedy was indicated, but perhaps not 
the right potency. It was then given in the 30th for a month or two, 
with continued improvement and without a return of the deafness. 

It would be difficult to decide whether the improvement was due to 
the change of potency or whether a sufficient amount of the 3x had 
been absorbed to complete the cure without further administration. 

It would be equally difficult to decide whether the 3rd cured too 
rapidly or produced a metastasis to the internal auditory apparatus. 
When she had nearly recovered the vaccination craze reached the 
city and she was vaccinated, with the hope that it might assist in a rad- 
ical cure. This not only made a very sore arm for a month or more 
but caused the eruption about the ears to reappear as before. After 
the disturbance from vaccination had subsided, Rhus tox was given for 
a short time and the cure was completed. It is now nine months since 
we have seen any sign of the eczema. 

* r r *: 

24 Bureau of Materia Medica. 

Case II. — Baby three months old, with an eruption about the 
genitals and anus, of a very red character. Different remedies were 
used without benefit, when it was discovered that the mother, who was 
nursing the child, had a high sp. gr. of the urine and a marked ten- 
dency to sugar. Thinking that the eruption on the baby was similar 
to or identical with the pruritis that sometimes accompanies this con- 
dition, a few powders of Kreosotum 3x were given to the mother, 
which promptly cured the baby. 

Case III. — Miss C, aged twenty; with an indolent ulcer of the 
limb for six months. It was half an inch deep and three or four 
inches in diameter. Before she came under my care, an " old school ,? 
physician had been flBing flaxseed poultices, which rather aggravated 
than benefited the trouble. At my second or third visit she explained 
how she happened to lose one eye ; of course I had noticed the loss, 
but did not refer to it especially, as it did not occur to me that it had 
any connection with the case. However, when she told me that it 
" ran out " when she was quite a small child, she gave me a suggestion 
that led to the selection of the remedy which cured the case. 

I suspected hereditary syphilis, and accordingly gave the Biniodide 
in solution. In three days there was a change for the better and in a 
month the ulcer was healed. This was the only treatment except the 
occasional use of Argentum nit. as a caustic. This case, and the one 
next preceding, would seem to suggest the importance of a correct 

Case IV. — Mrs. A., aged fifty-seven, complained of a griping, pinch- 
ing pain in the umbilical region, which would come suddenly, remain 
two or three minutes and then entirely disappear for nearly five 
minutes, to return as before. It was relieved by motion, and followed 
by marked prostration. Other symptoms and conditions were: tongue 
dry ; face pale ; very nervous and restless ; pulse weak ; and an old 
Quinine and malarial subject. Ars. one powder on the tongue gave 
immediate relief, and cured promptly. 

Case Y. — Mrs. B., aged thirty, and mother of two children. Epilep- 
tiform convulsions during menstruation. Actea promptly ^relieved, and 
trouble has not returned for several months. Her second child, three 
years, was attacked with chorea one year after birth. Several remedies 
have since been given with little or no avail until I decided to give 
Actea because of its action on the mother. The remedy has been taken 
only a short time, but marked improvement is apparent. I relate these 
two cases to show that by the good effect of Actea in each we have 

Bureau of Materia Medica. 25 

reason to believe that the two diseases stand related to each other as 
cause and effect. If this be true it follows that a nervous disorder of 
the mother may manifest itself in a different form in her child. 

Case VI. — Mi6s H., aged twenty-four. Complains of a loose cough 
in the morning for half an hour after rising ; during the day it becomes 
tight, pains constantly under the left shoulder blade extending down- 
ward and forward, heart feels constricted, breathing normal, yet a 
peculiar sensation is present. When the cough is relieved the pain is 
aggravated. The pain is of a throbbing character and is confined to the 
left side. Another important symptom, although not occurring more 
than once or twice a year, is a pulmonary hemorrhage, at times amount- 
ing to a severe loss of blood. Cactus grand, was given and followed 
by immediate relief and a permanent cure. 

Case VII. — Mrs. Q., aged twenty-six. Light-haired, German, and 
mother of three children. Has complained of a very severe intermit- 
tent neuralgic headache of the right side of the head, and especially of 
right eye, every seventh or eighth day for nearly four years ; particu- 
larly when nursing children. The pain usually begins in the morning, 
with a dizzy sensation in the top of the head, and will increase in 
severity for an hour, when it will be at its greatest intensity. It will 
then settle in the right eye, supraorbital arch, and retrain for twenty- 
four hours, when it will, quite suddenly, disappear to return again in 
about a week. The pain is of a lancinating character, and seems as if 
knives were being thrust in both the eye and temple and as though the 
eye must be held in to prevent its protrusion. 

At the beginning of each attack there is fainting, nausea, and vomit- 
ing, also pains extending into the bowels and ovaries. The neuralgia 
is aggravated by light, noise, and talking, and is partially relieved by 
warmth. Sept. 6th Silicea 3x was given, after repeated trials and 
failures with other remedies. 

Sept. 20th, she said the headache had been delayed four or five days, 
and it had not been so severe as formerly, nor had it affected the stom- 
ach. The remedy was continued. Oct. 6th, no return of neuralgia to 
this date. Oct. 15th, headache as usual. Soon after this she was con- 
fined to her bed for ten days with malarial fever and neuralgic head- 
ache. During this attack Ars. was given and followed by brilliant 
results. The fever and neuralgia quickly disappeared and for several 
months now have not returned. 

I think we may learn from this case that the indicated remedy can 
make a profound impression on some diseased conditions that are for 


26 ' Bureau of Materia Mrdica. 

the present incurable, but which after they have spent their force yield 
readily to treatment. 

Case VIII. — Mr. L., college boy, has complained of a hacking cough 
for three weeks, which was caused, undoubtedly, by cold and public 
speaking. There was a tickling sensation in the supra sternal fossa. 

The cough seemed to be aggravated .from four to eight p. m., and 
relieved by lying down and during the night. I made an exhaustive 
study of the materia medica and gave eight or ten prescriptions with- 
out the slightest benefit. He, naturally, became discouraged and bought 
a bottle of cough syrup, which completely cured him in two or three 
days. In this case 1 believe that the Morphine in the compound did 
the work, simply by relieving the irritation. No doubt there is a 
remedy that would have effected a cure, but I did not find it. 


By B. S. Partridge, M. D., 


Nearly a century ago there lived a celebrated French physiologist, 
Bichat, who announced the opinion that man possessed two nervous 
systems, and passed two kinds of life. One of these systems, — the one 
common to all organic life, — he called the vegetative or sympathetic ; 
the other he denominated the nervous system of animal life, or cerebro- 
spinal system. More recent investigations have established and demon- 
strated the existence and office of these two systems. 

The first, which we will denominate the organic nervous system, 
presides over and controls all of the functions essential to mere organic 
(animal or vegetable) existence, viz: innervation, nutrition, respira- 
tion, circulation, secretion and excretion. This is physiological life. 

The second class of nerves, called the cerebro-spinal, is not essential 
to animal life, but is an adjunct to enable its possessor to hear, see, 
smell, taste, feel and move, comprehend, combine, reason, appreciate, 
etc. This cerebro-spinal system derives its circulation and nutrition 
through the organic system, with which it is connected in a most 
intricate manner. 

Bureau of Materia Medica. 27 

No organism, whether animal or vegetable, can survive a moment 
without innervation. Charles Darwin has shown that all vegetable 
life is endowed with innervation, by which the functions of circula- 
tion, nutrition, respiration, secretion and excretion are performed. All 
forms of life are possessed of organs adapted to the performance of 
these functions, and these organs are under the control of innervation. 
Matteucci, Claude Bernard, Brown Sequard and others, have shown 
by extended and careful experiments, that the functions of any organ 
or part depends upon the integrity of its nervous supply, and only 
through some branch of the sympathetic, can any influence be exerted 
upon any of the functions of the organism. 

The normal performance of these functions constitutes health. In 
their aberration or disturbance we observe disease. Deprive the ani- 
mal or the vegetable of the power to perform any one of these essen- 
tial functions, and death will inevitably follow. 

Hahnemann says : " All morbid influences produce their effects, 
establishing disease, by disturbing the functions and feelings of the 
body." Since these functions are directly under the control of the 
organic nervous system, it must follow that all these morbid influences 
act through this system of nerves upon the various functions of the 

Hahnemann also tells us that the sensitive nerves receive drug im- 
pressions and transmit them almost instantly to all parts of the body. 

It seems to be the property of this system to receive the peculiar 
impression of any drug, and convey this impression in some mysterious 
way to a remote part or organ which that drug is known to influ- 
ence. The modus operandi is inexplicable. 

If we study the anatomy of this vast ganglionic system of nerves, 
we shall find that there is a great tendency to form intricate plexuses, 
which encircle the blood vessels and follow them to the viscera. From 
these plexuses are derived the vaso-motor nerves, which control the 
circulation. Through these each organ is supplied with a proper 
amount of blood for the normal performance of its function. If by 
any morbid influence there should be either excess or deficiency of 
blood in any part, the function would be increased or diminished, and 
disease would exist. Now the vaso-motor nerves control also the cir- 
culation in the brain and spinal cord. Hence any deviation from the 
normal functionalism of the cerebro-spinal system is traceable to some 
influence acting through the vaso-motors. Thus we have through gen- 
eral or localized cerebral hyperaemia, hallucinations, or mental aberra- 
tions. And so we come to the conclusion that morbific agents act, 

28 Bureau of Materia Medica. 

not through the cerebro-spinal system, but upon the vaso-motors that 
control the circulation in the brain and cord. 

Again, mental impressions often act through the vaso-motors to pro- 
duce some deviation from normal functionalism. How often do we 
see a perturbed mental state almost suspend the normal secretion of 
the gastric juice. In other cases a sudden emotion will occasion an 
excessive flow of urine. In the one case, the blood vessels of the 
gastric mucous membrane fail to dilate as in functional hyperemia, 
while in the other, dilatation of the renal vessels takes place in response 
to an influence exerted through the vaso-motors. 

Drugs, when taken into the system, act as irritants producing stim- 
ulation or excitation. They act, not upon passive tissues, such as bone, 
tendons, muscles, or blood, for these are insensible and could yield no 
response to irritation; but they act rather upon nerve tissue, which 
alone is susceptible of irritability, and through the nerves produce 
their peculiar effects upon the functions of the body. 

These effects differ in no essential respect from the influence of so- 
called natural causes of disease. 

It is by virtue of this irritant property of drugs that they become, 
under the law of similars, the agents curative in the hands of the thera- 
peutist. And it is through this great organic nervous system, which 
controls all physiological processes, that drugs are capable both of pro- 
ducing and of curing disease. 

The Single Remedy. 

By Edwin H. Woloott, M. D. 


Hahnemann many years ago, said that "In the treatment of disease 
only one simple medicinal substance should be used at a time." 

By admitting the unity of disease we will at once accept this as a 
practical statement and one that can be demonstrated on scientific 
principles. Many an argument has been made and many pages written 
defending combinations and alternations, but the weight of testimony 
is with the single remedy, which should always be our ideal in practice. 


Bubeau of Materia Medica. 29 

Any other coarse than this would lead as back to the field of "unmeth- 
odized clinical experience" back to empiricism and polypharmacy. 
It will be admitted that our practice is not up to our theory and that 
oar present knowledge is not sufficient to make it always safe to rely 
on the single remedy, yet we cannot for a moment doubt the truth- 
fulness and universality of the law. 

In this, as in every other field of research, the mark is always higher 
than we practically attain. This is a necessity, otherwise all could not 
aspire, by reason of intellectual inequality. There are instances when 
with our incompleted materia medica absolute adherance to the rule 
of the single remedy would seem impracticable. Such cases do not 
argue against the principle we profess to follow ; they admit simply 
that the intellectual attainments of the physician have not yet reached 
that state of perfection which makes this course possible in all cases. 
We are glad to note that while we are following our illustrious leader 
in giving the single remedy, our friends of the non-homoeopathic 
school have made decided progress in this direction. The famous 
prescription of Andromachus containing sixty-four drugs, has disap- 
peared, and we have now the convenient tablet triturate which seems 
to be common stamping ground for many physicians in both schools of 
medicine. They, as well as we, are passing from conglomeration to 
individualization, and are fast assigning each and every drug to its 
proper place, surrounding it by its own specifications and limita- 
tions, being more definite and particular and thus progressive. It 
is often the question with them, as it always should be with us, 
is this a case of Nux vomica or Pulsatilla ? And not one of Nux 
vomica and Pulsatilla. 

This advancement is also in keeping with that made in the collateral 
sciences; in biology the different anamalculse and bacteria are each 
receiving attention and study, and are being definitely understood It 
is not enough that electricity is indicated, but the quality and quantity 
are absolutely necessary if we would effect relief. 

The microscope furnishes a ready illustration in that it is not suffi- 
cient that epithelium is present in a given specimen of urine, but the 
kind is wanted, as differentiating between renal and cystic disease. 
The single remedy in medicine is therefore a direct product and 
natural result of scientific investigation. On this basis we can claim 
the recognition and support of intelligent men ; on this basis the 
declaration of Hahnemann means something more than a simple asser- 
tion ; on this basis the single remedy will stand forever. 

30 Bureau of Materia Medica. 

We are thus tending more and more towards definiteness and 
individualization of drags ; and the time is coming when each shall 
have its own place in the materia medica, not that we may ever expect 
that a homoeopathic prescription will be a drastic cathartic or a power- 
ful emetic but that it will reign supreme "within its sphere" and 
conglomeration and alternation will be a thing of the past. 


By M. W. Van Denbueg, A. M., M. D. 


No stronger proof of Hahnemann's greatness is needed than the 
immense influence his thought has gained over the medical world dur- 
ing the past half century. Though less than that since he died, full 
of years and of honors, yet half a century may be assumed as having 
elapsed since his literary work was completed and his doctrines fully 

Our own is preeminently an age of revisions. But the works of 
few men have been so little subjected to this process as those ot 
Hahnemann. What he did, and what he left as monuments of his 
labors, have been regarded with almost religious veneration. 

It seldom falls to the lot of any man to have his entire work, after 
the lapse of half a century, still held in such reverence. 

The advance of knowledge during the last fifty years has necessi- 
tated revisions in nearly every branch of science. Progress always 
demands changes. Why then have the works of Hahnemann escaped ? 
It will be worth our while to pursue this inquiry. His literary and 
scientific works may be classified under four heads. 

First — The discovery and establishment of the law of similia. 

Second — His drug provings, or Materia Medica Pura.* 

Third — His Philosophical Writings. 

Fourth — His Polemical Writings. 

Concerning the discovery of the law of similia it can be truly said 
this is ample glory for one man. Though it should be proven that he 
had failed in everything else, yet in that he succeeded in firmly plant- 

Bureau of Materia Medica. . 31 

ing this one truth in medical science, Hahnemann's immortality was 
assured. He thenceforth securely took his place among the few uni- 
versal heroes. 

Passing, for the present, the second on the list, we come to his 
Philosophical Writings. These must of necessity fade away in part, if 
not altogether. 

Carroll Dunham has felicitously said : " A man's observations of 
natural phenomina, if he be a keen and accurate observer, as Hahne- 
mann unquestionably was, are generally correct; but his theoretical 
explanations of them are pretty certain to be tinctured with the pre- 
vailing philosophy of the times in which he lived, and are not likely 
to be accepted without modification by men of a later period." 

This is a universal law, conditioned upon the advancement of knowl- 
edge. The philosophy of Hahnemann did not rise far enough above 
his times to escape its force. His theoretical and speculative explana- 
tions will be demolished and buried out of sight by the relentless 
march of time. But there are also many coins from his brain that 
bear the stamp of universality and have the ring of pure metal. Many 
such are found in the Organon, but many others are there mixed with 
them that have long since ceased to pass current, and Hahnemann, 
were he living in this age, would be the first to repudiate them. 

Of the solid gold are such as relate to the application of the law 
of similia to a given case ; how to study your patient ; how to study 
your remedy. These are not theoretical deductions, but scientific 

The fourth and last division is the Polemical Writings. These 
are found scattered everywhere in all Hahnemann wrote except Materia 
Medica Pura. They have seen their greatest day, and have largely 
accomplished the object whereto they were sent forth, in mollifying 
the "regular barbarity" of treating diseases. No greater boon has 
ever been bestowed by one man upon suffering humanity than the 
modification and moderation brought about by Hahnemann in the 
administration of drugs. The entire civilized world, to the farthest 
limit of European influence, has felt his beneficent touch, and does 
not today know one tithe of the gratitude it owes this heroic man. 

Returning now to the second division of the analysis of Hahne- 
mann's works, the Materia Medica Pnra, we find that his influence on 
this department has been autocratic. The materia medica of to-day 
bears in every part, and on every line, the stamp of his sign manual. 

The factors of Hahnemann's Materia Medica, are three : 

First — The observation of drug phenomena. 

32 Bureau of Materia Medica. 

Second — The manner of recording those observations. 

Third — The method of arranging them. 

Of the first it is pretty safe to say Hahnemann's skill has seldom 
been equaled, and probably never surpassed, in keen, accurate and 
thorough observation. Subsequent investigation has tended for the 
most part to confirm rather than supplant his personal pathogenesy. 
But this is not true of all he recorded. Others observed and he 
accepted their record. These symptoms are not always trustworthy. 

The second factor, his method of recording observed drug phenom- 
ena, is still in full vogue, and is about equally conspicuous for. its 
virtues and its faults. 

The short, crisp sentences ; the sharp isolation of each incident and 
its careful individualization, are in several ways elements of strength. 
They tend, though they do not compel, to any equally careful analysis 
of the symptoms of the patient. They enable us to make clear dis- 
tinctions between different drugs. They tend to individualize various 
phases of the same disease in different epidemics and in different 
cases. These are no doubt valuable points in applying the great law 
of cure. 

But on the other hand, by this process of isolation the concomitance 
of drug symptoms is hopelessly broken up, and they are likely to 
remain permanently scattered to the four winds of heaven, thereby 
destroying one of the most valuable elements in pathogenesy. 

With the present state of our materia medica no task is more labori- 
ous than the construction of a complete picture of concomitant symp- 
toms. Yet on this, more than on any other one element, depends the 
successful employment of homoeopathic remedies. 

Under the present arrangement of cutting each symptom off by 
itself a half-dozen concomitant symptoms may be scattered, each 
restricted to less than one line, through half a dozen or a dozen pages, 
and the task of reconstruction rendered impossible. One of the ele- 
ments of failure of homoeopathic drugs is the want of concomitance. 
Let me not be misunderstood. A given drug is selected, one, we will 
say, that has four symptoms which correspond with four leading symp- 
toms in the patient. Two of these drug symptoms have never been 
evolved in connection with the other two in any proving of the drug. 
But two other symptoms have always attended the first two in the 
drug provings, and are entirely wanting in the patient. The doctor 
thinks he has four good corresponding symptoms, whereas he has only 
two, and these two are disassociated with their constant concomitants. 
How is he to know this from the study of his books ? What is the 

Ires reported 



Confusion, &o. 
Pain in Head. 
Outer Head. 
Face in Gen. 

Jaws and Glands. 




Lower Jaw. 


Teeth and Saliva. 




Mouth in Gen. j 

Tonsils and Throat. | 

Deglutition. i 




Nausea and Vom. 








Catarrh and Cough, 



Respiration and 
Skin of Chest, 
Breasts (Fem.) 

Spinal Column. 

BacSand Scapulae. 

Upper Extrem. 
Lower ** 
Skin of L. " 
Limbs in Gen. ■ 

Restlessnes & Mood! 




Chills and Coldness, 






Delirium and Its 


most contra- 
ki from each 
ad without a 

Lis preface: 
B on materia 
Bst array of 
le stands dis- 
' subject will 
rsterious awe, 

[ahnemann is 
terated to-day 
teria medica, 
f the totality 
No man can 

day books of 
tot ? Because 
irae, a bushel 
ve found the 

Certainly no 
anything else. 

we of to-day. 
ledy. In his 
t the present 
; from expen- 
se of ref resh- 

^anderbilts, it 
ie nation. It 

3pace demand 
re important f 

rpowering. A 
^rom Hahne- 


34 Bubeatt of Materia Medio a. 

mann down to the present, will show this more clearly than mere des- 

It is but fair to say he has been copied, without improvement or 
change of importance, down to the time Dr. B. F. Underwood's little 
work on materia medica appeared. Dr. Underwood made quite a 
radical change, but not radical enough to remedy the evil. 

A superficial survey of the Hahnemannian arrangement leads to the 
conclusion that the fundamental idea is anatomical relationship. 

A more careful examination reveals the fact, that in part at least, it 
is physiological, while incidents purely mental, moral, or vital, are put 
in haphazard, with very little regard to relationship. 

To be specific, the Hahnemannian arrangement of Belladonna symp- 
toms are after this sort : 

Beginning with Confusion, a mental symptom, there follows Pain 
in the Head, a nervous symptom; Outer Head, a combination of nervous, 
tissue and skin symptoms ; Face in General, combining all three and 
adding a fourth ; Expression, a vital symptom ; Eyes, a special sense, 
hence, functional, tissue, nervous symptoms combined ; Jaws and 
Glands; Ears, another special sense; Nose, a combination of respiratory, 
special sense, tissue and skin symptoms ; Lips, Lower Jaw, Larynx ; 
again respiratory symptoms mixed with several other classes, one of 
which is the functional Voice, Teeth and Saliva, Mouth, Tongue, 
Speech, Mouth in General, Tonsils and Throat, Deglutition, Taste, 
Appetite, Eructation, Nawea and Vomiting, Hiccough, Stomach, 
Abdomen, Bowels, Stool. 

If now we attentively examine the order down to tonsils and throat, 
and perhaps one or two groups beyond, of a functional nature, the dom- 
inant idea of arrangement, seems to be anatomical relationship. 

But beyond this point, that idea ceases, for the time, to guide ; else, 
why do we not have Bronchi, Lungs, Heart, Respiration and Circula- 
tion, the symptoms under Chest, precede Stomach, Bowels, etc. 

The reason for the present arrangement is the physiological connec- 
tion of the parts, and the absurdity of the anatomical idea that was 
apparent at first, becomes now intolerable ; hence the change. 

From this point on we have a strange medley. Sometimes the ana- 
tomical idea prevails, but more often the physiological, and frequently 
the struggle between, the two, is only too evident in the manifest 
absurdity of the decision. 

Taking up the Kubrick at the point already reached, we have the 
physiologically connected Genito- Urinary systems in the following 

Bubeau of Materia Medioa. 35 

order : Urine, Male Organs, Female Organs, (but not the female 

Again, we take up next the physiologically connected Respiratory 
System, Catarrh. We have had Nose (and frontal sinuses implied,) 
a long way back, and must now go back for it, if we want the connec- 
tion complete, Cough, Goryza, Chest, (meaning lungs, Bronchi, Heart 
and Circulation in part at least,) Shin of Chest, and Female Breasts. 

Here was a grand struggle for dominance between the two ideas, and 
anatomy won the day. "What advantage materia medica gained thereby 
is not apparent. 

Next on the list is, Spinal Column, Bach and Scapulce, Shoulders, 
Upper Extremities, Lower Extremities, Shin of Lower Extremities, 
Limbs in General; a good list of tissue symptoms, together with a 
large part of the nervous system and a patch of skin symptoms thrown 
in to complete the bargain. 

At the very beginning was placed a mental symptom, Confusion. 
This we have experienced more or less all the way down to the present, 
and now we meet for the first time with congeners, Restlessness and 

Closely allied are Sleep and Dreams, but Thirst again trips us up. 
Taken, however, together with what follows it is not so bad : Thirst, 
Chills and Coldness, Fever, Inflammations, Rash, Sweat. Here are 
fever phenomena, tissue phenomena, that may or may not be attended 
by general fever, and skin phenomena that also may or may not occur 
with febrile excitement, placed between two elements of the febrile 

And now, once more, we come upon purely mental phenomena : 
Anxiety, Delirium and its Moods; Madness. 

It would seem little less than madness to justify such an arrangement 
as this in this day and at this stage of progress. 

The most that has been done is to patch up some of the most glaring 
defects. A hasty comparison of the prevailing Kubrick with Hahne- 
mann's own will show how true this is. 

It is not incumbent upon us, as good and faithful disciples of Hahne- 
man, to copy his faults as well as his virtues. Neither are we called 
upon to regard him as inspired or infallible. He himself would be 
the first to repudiate such implications. It is rather our part to inquire, 
in the calmest scientific spirit, what is required of Materia Medica 
Pur a f 

The first requirement is that it be truthful. The universality of the 
law of similia is not here under discussion, only materia medica. The 

36 Bureau of Materia Medic a. 

second requirement is that it should be available for use with the least 
possible expenditure of time and labor. 

Efforts in this direction have been untiring. We have condensed 
and recondensed materia medicas ; repertories large and small have 
consumed years of patient labor, and helped in a very large degree to 
make up for deficiencies and confusion. Without them it is hard to 
see how we could practice medicine at all. 

But candidly considered, we have not yet reached perfection. The 
truthfulness of the greater part of Hahnemann's work has been con- 
ceded. So also the investigations of many others now incorporated in 
the common stock. That there is need of still further sifting and 
exclusion is not denied ; but this is not now the most important desid- 
eratum. It is of vastly greater importance that the second requirement, 
the availability, be considered. This is indeed the great question of 
all others presented for our solution at this stage of the history of 

Material has so multiplied on our hands that it is simply impossible 
for any one man to use rao;e than a third or a fourth part of the drugs 
on our lists. Of the thousand and more drugs accredited to Homoe- 
opathy no one man uses, first and last, above four hundred. In some 
statistics I have been collecting during the past year, no man has 
reported more than three hundred and twenty-five drugs as used by 
himself. Our own Dr. §. Lillienthal reported one hundred and twenty- 
five as the limit of his repertory. The large majority of drugs put 
down in the books are superfluous. 

But when the number has been reduced to something like a reason- 
able limit, the requirement of availability is not yet met. As has been 
said, a radical change must be made in the arrangement. 

No navigator ever yet sailed by two irreconcilable charts and avoided 
the rocks, except by sheer good luck. Neither his skill nor his science 
were to be praised if he escaped shipwreck. 

Materia Medica arranged under two ideas, as irreconcilable as ana- 
tomical relation and physiological connection, can but be confused and 
confusing. Either the one principle or the other, or some third one 
differing from either, must be followed consistently, or failure must 

We are called upon as physicians to study living and not dead phe- 
nomena ; hence physiological and not anatomical. 

To render materia medica available in the highest degree, the arrange- 
ment of its symptoms should correspond as nearly as may* be to the 
order in which they are likely to appear in the patient. This is in the 

Bureau of Materia Medica. 37 

physiological order, hence the physiological is most likely to be the 
proper fundamental idea. 

Such a basis involves an entire reconstruction of the Hahnemannian 

Under the physiological arrangement the following general heads are 
proposed : 

First. The Moral and Mental Phenomena and the Nervous System. 

Second. The Respiratory and Circulatory Systems. 

Third. The Digestive System. 

Fourth. The Genito-Urinary System. 

Fifth. The Muscular, Fibrous and Osseous Systems. 

Sixth. The Skin and Superficial Glandular Systems. 

The Fourth, the Genito-Urinary System, may be included under 
two distinct heads or combined in one, it is not material either way. 

The various symptoms now given under each drug will be grouped 
conformably with this arrangement. 

Materia Medica classified in this way will be made more available for 
the following reasons : 

First. The scheme is readily comprehensible, thereby avoiding con- 

Second. A comprehensive view of the drug and its sphere of 
physiological action is more readily obtained. 

Thiri. As has been already intimated, it will more merely corres- 
pond to the grouping manifested by the symptoms of the patient. 

Fourth. The order is the same as that employed in other text-books 
on kindred topics, physiology, pathology and physical diagnosis. 
Hence no new order will need to be learned. 

But this rearrangement here proposed will not remedy all the evils 
of the present system. 

One already mentioned will be removed in only a very slight degree, 
that is the lack of concomitance of symptoms, under the present 

A method of lettering or numbering, or in some other way indicat- 
ing such symptoms as are concomitant, would help in part, but noth- 
ing will ever fully atone for the complete and exclusive picture of drug 
action at a given stage of its pathogenesy. 

This demands another basis of treatment than that proposed in the 
Physiological Arrangement. 

In addition to the reasons already given for the proposed change one 
more deserves our thoughtful consideration. A decided gain may 
rightfully be expected from the ranks of " our friends, the enemy. " 

38 . Bureau of Materia Medioa. 

Homoeopathy is still in the minority, and very largely so. It has 
grown vigorously, but not so fast as it might have done had we 
possessed a more readily comprehensible materia medica. The two 
schools are drawing nearer to each other every year, but the concessions 
of homoeopathy are as nothing compared to those made by the other 
school. We have not abated one jot or tittle from our main principle, 
the law of similia. 

On the other hand the leading drug houses of the other practice 
throughout the land are vieing with each other to see who shall 
place on the market the largest line of tablet triturates in doses small 
enough to make the skeletons of the allopaths of the last generation 
rattle in their graves with indignation. Our allopathic brethern are 
learning the efficacy of small doses, and if their manufacturers improve 
during the coming three years at the rate of the last three, high potency 
homoeopaths may obtain their supplies from almost any allopathic 

If now we offer them a comprehensible materia medica, we shall 
yet many of us live to see the day when homoeopathy will be in the 
majority, and not as now only a respectable minority. 

Homoeopathy is botind to be the medical science of the future, for 
it possesses the fundamental truth of the healing art. 

With us of to-day rests the responsibility of helping or hindering 
this consummation. 


Dr. Van Denburg : I have been collecting statistics on the use of 
drugs for over a year past, and would like an expression in regard to 
the use of the " single remedy." I find many of our best men all over 
the country alternate very frequently in using drugs. Personally I 
alternate more than I wish I did. My finest results have been obtained 
with the u single remedy." 

Dr. A. S. Ball : Related his conversion to homoeopathy. As an 
old school physician, he was treating a case of meningitis which he 
failed to benefit. He then privately consulted a homoeopathic physi- 
cian, who suggested the use of Bell. 3x, which produced an aggrava- 


Bureau of Materia Medioa. 39 

tion on the second dose. The remedy was suspended and improvement 
continued until the tenth day, when Phos. was substituted and fol- 
lowed by Hepar, which completed the cure. 

Dr. Gorham believes it more satisfactory to use the single remedy. 
In chronic cases he prescribes but one remedy, while in acute cases he 
gets better results by alternation. 

Dr. Beldin : The Monotropa uniflora may be classed in the old 
adage as " death on fits." In convulsions produced by an injury to 
the head, by a fall or otherwise, I have never known it to fail to bring 
about perfect convalescence. I have used it in a case where there was 
continued convulsive tremor, which had lasted fourteen hours. 
Although it had been under regular treatment with Bromide of Pot- 
assium all that time without any relief, Monotropa, ten drops of the 
tincture in a gill of water, a teaspoonful every half hour, relieved the 
spasm in one hour ; recovery perfect. 

Pathology is all very well, but of what benefit is it if the drug has 
not been proven ? Must we give up the use of all drugs known to 
cure certain diseases simply because there is no pathology attached to 
them ? 

Dr. Everttt Hasbrouck failed to get any beneficial results from 

Dr McMurray : In selecting our remedies think we take too little 
account of the pathological conditions. Must find out what the trouble 
is. Our school has been too great a slave of symptomatology. 

Dr. John L. Moffat: Reliance upon subjective symptoms is 
one of the weak points in our school. A knowledge of the physio- 
logical and pathological action of each drug is essential to its proper 
study and its application to the totality of symptoms. 

Another crying evil among us is such empirical reports as this 
" cure of fits " just presented. Except as an example of how not to 
do it, the time of this Society should not be wasted over such unscien- 
tific, crude assertions. There can be no specific for u fits." If we are 
to learn anything from our brother's experience in this instance he 
should have presented the symptoms and history of one or more cases 
so clearly that we could each of us corroborate his diagnosis, and then 
should have demonstrated that no other change in the patient's environ- 
ment but the ingestion of this medicine could have caused the disap- 
pearance of the symptoms. 

As to the single remedy, I must confess that I alternate in a large 

40 Bureau of Materia Medica. 

proportion of ray prescriptions ; but when I do cure, my most prompt 
and satisfactory results have been from the single remedy, and this 
fully as frequently in acute as in chronic cases. Alternation is mostly 
habit (and a bad one), but is also a confession of ignorance or uncer- 
tainty. However great the benefit to our patients, such clinical 
results deserve no place in our literature and societies ; they teach us 
so little that our time can be better occupied otherwise. 

Dr. Boooock : We often alternate, because we are afraid to risk a 
single remedy. It is hard to get out of the rut of alternation. 

Dr. Henry M. Smith : It is my practice to use a single remedy, 
and am sometimes led to its selection by one or two symptoms. Dr. 
Hering said three legs were necessary for a stool to stand on, so if you 
had three prominent symptoms of a drug to guide you, you would fre- 
quently find that the pathogenesy of the drug would also embrace 
many of the other symptoms of your patients. This view was also 
held by Boenninghausen. One indication for Cina, given me by Dr. 
Dunham, where, in intermittent fever the chill begins at the top and 
runs down the spinal column, has served me in other cases than inter- 
mittents. I have prescribed Ferrum phos. 6, with success in the 
commencement of inflammatory conditions where Aconite has usually 
been given, and in one case of intermittent fever, I first saw in 
the second paroxysm, this remedy given during the fever was the only 
medicine exhibited, the patient having no subsequent attack. 





Evkritt Hasbrouck, M. D., Chairman, - - Brooklyn. 
D«8. Wm. N. Guernsey, l New York City. 

Phosbb J. Waite, New York City. 

W. W. Blackman, .... Brooklyn. 

Henry Minton, - Brooklyn. 

George E. Gorh am, - . - - Albany. 

J. N. Tilden, Peekskill. 

W. H. Proctor, - Bingham ton. 

Edwin Fanohbr, Middletown. 

C A. Groves, Ticonderoga. 

J. W. Candee, Syracuse. 

Wm. A. Allen, Flushing. 

S. P. Burdick, ----- Oakland, Cal. 

D. B. Stumpf, Buffalo. 

Disputants: Drs. L. L. Danforth, New York City. 

J. Nicholas Mitchell, Philadelphia, Pa. 



W. W. Blackman, M. D., 


In discussing the causes of the albuminuria of pregnancy we shall 
exclude such causes of renal disease as exposure to cold when the body 
is overheated ; its predisposition from scarlatina or any other acciden- 
tally present etiological influence, and confine ourselves to the consider- 
ation of this pathological condition which is really due to pregnancy 

*No report from Bureau of 1887. 

42 v Bureau of Obstetkics. 

As a disease, dependent entirely upon the pregnant state, little or 
nothing was known of it until a comparatively recent date. It is 
now known to be one of the most f requent complications of pregnancy. 
It is so trivial sometimes as to cause "no disturbance of pregnancy or 
parturition," while on the other hand %4 it may give rise to most alarm- 
ing and dangerous syniptoms in the pregnant, the parturient, and the 
puerperal woman." 

Albuminuria is no longer regarded as a symptom of Bright's disease 
only, and it is probable that in 90 per cent, of the cases of albuminuria 
of pregnancy the structural lesions of the kidneys, implied by the term 
Bright's disease, do not exist. Indeed it has been shown recently that 
the albumen of Bright's disease and that found in the albuminous urine 
of pregnancy are not identical in character. Chemical reactions show con- 
clusively that the albumen of Bright's disease is essentially different 
from that found in the temporary albuminuria of pregnancy. " The 
albumen of Bright's disease when brought in contact with the Oxide of 
Copper, assumes a beautiful redish, violet color and produces a more or 
less abundant flocculent, black precipitate." Now "the urinary albumen 
of pregnancy, when Bright's disease does not exist, while it coagulates 
readily by heat and Nitric acid, does not exhibit any such reaction with 
the Oxide of Copper." 

Why should albuminuria so commonly exist during the pregnant 
state is a question that naturally arises. 

Statistics show that a majority of cases occur under certain conditions 
and from these facts various theories have been deducted. Albu- 
minuria makes its appearance most frequently during the latter months 
of gestation ; attacks primiparae more commonly than women who 
have already borne children ; in multiple pregnancies it is seldom absent; 
it occurs oftener in young women than those of a more advanced age ; 
it ceases at once or soon after the pregnancy is over. It attacks preg- 
nant women in every class of life ; occupation and habits are without 
influence in its production ; it is found in robust, plethoric women as 
well as those of a more feeble habit. It may complicate one pregnancy, 
be absent in the next and recur again in the third. Rayer reports a 
case where it was developed for the "first time during the seventeenth 
pregnancy in a woman who had previously passed through sixteen per- 
fectly regular and uncomplicated pregnancies." It has been found that 
hyperemia and parenchymatous inflammation does not always exist 
alone in the kidneys but that a congestion and inflammation of the 
liver and even of the spleen is sometimes coincident. 

Bureau of Obstetrics. 43 

It has been argued and the theory is very generally accepted that 
the albuminuria of pregnancy is the result of a mechanical interference 
with the venous circulation in the abdomen just as we have albuminuria 
and degeneration of the kidneys in valular lesions of the heart. The 
facts that this complication of pregnancy occurs more frequently dur- 
ing the latter months of gretation, when the uterus is considerably 
enlarged ; is more commonly met with in primiparae whose abdominal 
walls are more tense and unyielding than in women who have already 
had children ; that it is almost invariably present in multiple pregnancy, 
and that the albuminuria ceases at once or soon after the pregnancy is 
over, have led many to affirm that this condition is due to an obstructive 
hyperaemia of the kidneys consequent upon the pressure of the 
enlarged uterus upon the renal veins. On the other hand the consid- 
eration of the relative position of the abdominal organs tends to show 
how inadmissable is this theory, and there are also other facts which 
refute the arguments in its favor and show how untenable it is. In the 
first place, from the very nature of its position, the right renal vein, lying 
as it does in a concavity on a plane posterior to the anterior surfaces of 
the bodies of the vertebrae, is protected from pressure from the dis- 
tended uterus. Yet autopsies reveal the fact that both kidneys are 
affected alike and that the right is as likely to be involved as is the left. 
In the majority of case6 the left renal vein crosses the vertebral column 
above the second lumbar vertebra. It is sometimes found in front of 
the intervertebral substance between the first and second lumbar verte- 
brae and occasionally lies as high as the body of the first. Now the 
lower end of the uterus is concealed in the cavity of the pelvis. In order 
to touch the anterior surface of the body of the second lumbar vertebra 
it would have to be bent backward at a considerable angle at the prom- 
intory of the sacrum. It is evident that this flexion would be pre- 
vented by the round ligaments. Autopsies held on the bodies of women 
who have died in the advanced stages of pregnancy show that the uterus 
is held in close contact with the anterior abdominal walls by these 
ligaments and between the posterior surface of the uterus and the 
bodies of the lumbar vertebrae there is a triangular space with its 
apex resting upon the base of the sacrum. This space is filled in by 
coils of intestines, filled with gas, which act as an elastic cushion pre- 
venting pressure upon the posterior abdominal wall. As stated above 
changes analogous to those in the kidney are in some cases developed^in 
the liver also during pregnancy. It is reasonable to suppose that both 
are due to the same cause. Can the gravid uterus produce hyperaemia 
of the liver from mechanical obstruction ? Let us see. Now in order 


44 Bureau of Obstetrics. 

to get this obstructive hyperemia of the liver there must be a damming 
up of the hepatic veins. "These veins commence in the substance of 
the liver in the capillary terminations of the portal veins and hepatic 
artery and cou verge to form three trunks which open into the vena cava 
while that vessel is situated in a fissure appropriated to it at the back of 
the liver" beyond the possible reach of pressure from the enlarged 
uterus. If the increase in the general pressure in the abdominal cavity 
which the enlarged uterus causes, can give rise . to stasis in the renal 
veins why does not this obstruction, and therefore the albuminuria 
exist in cases of large ovarian tumors or in instances of extreme disten- 
sion of the uterus by " hydraminos " ? The occurence of the renal dis- 
ease in those pregnant women who have excessively developed pendu- 
lous abdomens also argues 6trongly against the theory of mechanical 
pressure. The fact that the albuminuria ceases at once or soon after the 
termination of the pregnancy proves nothing more than that the preg- 
nancy was the cause of the renal disease. It must be remembered that 
with the emptying of the uterus by the birth of the child a great change 
takes place in the distribution of the blood to the abdominal organs — a 
change well sufficient to remove a hyperemia of the kidneys. The 
blood of the pregnant woman is usually more watery and contains more 
fibrin than normal blood, the quantity of albumen and red blood corpus- 
cles is diminished while the white corpuscles are increased. Some have 
thought this change of the blood causes the presence of albumen in the 
urine. Ferichs places this alteration in the constitution of the blood in 
pregancy by the side of that of "crasis" on which depends those cachec- 
tic conditions — suppuration, ulceration, etc. — that are produced by long 
continued discharges of albuminous materials, and he ascribes it to the 
impoverishment of the blood consequent upon the drain of nutritive 
materials required for the nutrition of the foetus. This theory is also 
untenable, for the renal disease frequently attacks the most robust and 
"blooming 1 ' of women whom it would be absurd to call cachectic. 

Dr. Tyler Smith, of London, suggested years ago that albuminuria 
may depend upon sympathetic irritation of the kidneys by the gravid 
uterus similar with the irritation of the salivary glands, the mammae, 
etc. Some writers have attributed the disease to the additional work 
thrown upon the kidneys during pregnancy, when they are compelled 
to eliminate a larger quantity of excrementitious matter. Others 
have referred its origin to some deleterous substances which might be 
contained in the blood during pregnancy. These substances, however, 
have never been detected. 

Bureau of Obstetrics. 45 

Until recently, the albuminuria of pregnancy was associated and 
studied in connection with eclampsia, and for a long time was looked 
upon as essentially the cause of these convulsions. This was based 
upon the supposition that the convulsions were due to uremic poison- 
ing. Albuminuria and uraemia, however, are not identical terras, as 
either condition may exist independent of the other, though it is prob- 
able that the former cannot exist to any considerable extent without 
more or less uraemia. In considering the relation of albuminuria to 
puerperal convulsions, Fordyce Barker says : (1) " There are cases of 
puerperal convulsions having all the characteristic phenomena which 
attend this fearful malady in which there have been no symptoms indic- 
ative of any lesion of the kidney. The most careful and repeated 
examinations have failed to detect albumen or casts in the urine, either 
before or after the occurrence of the convulsions." (2) " In a large 
proportion of marked cases of albuminuria during pregnancy convul- 
sions do not occur." (3) " In many cases where the most careful and 
repeated examinations of the urine have failed to detect albumen, and 
there havf been no other signs of albuminuria, convulsions have 
occurred and afterwards the urine has been found loaded with 

This tends to show that the two conditions are dependent upon some 
common cause instead of bearing the relation to each other of cause 
and effect. 

Frankenhauser, of Jena, has recently demonstrated, by careful dis- 
sections, a direct connection between the nerves of the uterus and the 
renal ganglia. He reasons that the nervous system and not the venous 
system is the starting point of albuminuria and puerperal convulsions. 
" Have we not some reason for believing that the convulsions, the 
albuminuria and the lesions found in the liver are the effect of some 
common cause, the exact nature of which has not been determined ?" 

Therefore, as Bartels says, " there is nothing left for us but to record 
the fact that parenchymatous inflammation of the kidneys, and even 
the liver, may be developed during pregnancy, and to confess that we 
do not know what causes them." 

46 Bureau of Obstetrics. 

The Effects of the albuminuria of 


Wm. A- Allen, M. D., 


Albuminuria may be defined as the existence of albumen in the urine, 
such albumen having found its way from the renal bloodvessels, and more 
especially from the glomeruli into the tubuli uriniferi. Transient 
albuminuria may come from a number of causes, among them severe 
exercise, albuminous diet, irritation of the renal nerves and of a spot 
on the floor of the fourth ventricle, the injection of water into the veins 
and certain febrile conditions. Blood, pus and semen, when present in 
the urine, responds to the tests for albumen, but thfe albuminuria which 
we shall consider has its origin in the exudation of blood or albumen 
through the walls of the afferent or efferent blood vessels of the kidneys 
or through the glomerular epithelium, as already stated, and results from 
the condition of . pregnancy. The presence of albumen in the urine 
does not necessarily imply a structural change in the kidneys, at least to 
the extent of Bright's diseases, nor that there coexists a condition of tox- 
emia from the presence of urea creatine or creatinine, but when albu- 
minuria is prominent the blood poisoning is so often intimately associated 
with it, that in the consideration of the effects of albuminuria, attention 
should also be called to the concomitant condition of uraemia, even if 
the subject of Bright's disease be excluded. The effects of the albu- 
minuria of pregnancy may in a general way be stated to be similar to 
the effects of albuminuria and ureemic poisoning arising from other 
causes than the puerperal state. Albuminuria during pregnancy is 
most apt to occur in primiparae. There is no doubt but that when it 
has once existed it is more liable to be present in, subsequent preg- 
nancies, yet such is not always the case. 

Should it exist during pregnancy, it is usually at a period of gesta- 
tion at or subsequent to the third month. It may be slight and no 
unpleasant symptoms arise from it; but should it become marked, the 
more prominent symptoms are debility, nervous prostration, cephalagia, 

Bureau of Obstetrics. * 47 

with a sensation of cerebral hyperemia, rigors, oedema of the extrem- 
ities or general anasarca, pains in the loins, dyspnoea, anaemia. There 
may be dimness of sight and amaurosis. The urine is more or less 
albuminous. The specific gravity, nature of the casts, (if they be 
present), amount of albumen and of urea, vary is different cases. If of 
a low specific gravity, a sadden and marked rise in specific gravity is 
usually of moment. So far as the foetus is concerned, albuminuria and 
the general condition associated with it may prevent the foetus from 
attaining its normal development and tone, even if it remain in utero 
for the full term. The same rule applies to the placenta. Waxy and 
fatty degeneration of the latter may be present during albuminuria, 
but are not dependent upon it. At the time of delivery \ ^albuminuria 
and coexisting ursemia may cause convulsions. While the presence of 
these spasms at this time is often owing primarily to the blood poison- 
ing, still they are often developed by the hypersesthesia and the pres- 
sure upon the cerebral blood vessels incident to labor, and to the irrita- 
tion of the nerve centers either intracranial or in the spinal cord. This 
irritation may be direct, as by the formation of a clot within some portion 
of the brain, *or may be caused by the reflex action brought about by 
the pressure on, and the passage of the foetus and especially of the 
foetal head through the os, the vagina or the vulva. Excessive blood 
pressure or the opposite condition from loss of blood, are both exciting 
causes of convulsions, and so are impacted feces, gastric irritation and 
the irritation caused by drastic cathartics. The mere pressure of the 
foetus in utero, the distension of the uterus by the liquor amnii, the 
operation of turning, or that of delivery by the forceps, the extraction 
of the placenta, either with or without the introduction of the hand 
within the uterus, may bring on convulsions. These conditions may 
produce spasms acting independently of uraemia, but when it is present, 
even in a moderate degree they are much more apt to lead on to con- 
vulsions than when existing without it. 

Urflemic convulsions are apt to be ushered in by headache. There 
is pain and a feeling of weight in the vertex, forehead, orbits or back 
of the neck. Vomiting is often an early symptom. Daring pregnancy 
vomiting, especially where there is a clean tongue, should be regarded 
with suspicion. The headache is usually followed by drowsiness and 
twitchings of the voluntary muscles of an epileptic type. There may 
be a single paroxysm or a succession of paroxysms. The spasms are 
apt to be followed by coma. During the period of remission between 
the convulsions, we have stertorous breathing, pale face, dilated pupils, 
drowsiness, with a semi comatose state, from which the patient can 

48 Bureau of Obstetrics. 

usually be partially roused. There are defects of sight and hearing, 
and diarrhoea may be present. So far as vision is concerned, the blind- 
ness may be either temporary or permanent. Objects frequently appear 
as though veiled in mist. The opthalmoscope fails to reveal any change 
in the eye excepting that the retinal vessels are distended with blood. 
They are not ruptured, as in retinitis apoplectica. Uraemic deafness is 
not as frequent as are the defects of vision. It should be stated that 
uremic coma may come on suddenly and without preliminary symp- 
toms, and resemble an attack of apoplexy. The condition of the eye 
and the accompanying symptoms will serve in making a diagnosis. It 
was stated, when considering the condition of the foetus and that of the 
Placenta during gestation, that the foetus might not be properly nour- 
ished and might be wanting at least in tone. The result is, that at the 
time of birth the child is not possessed of proper vis vita. It is not 
perhaps a normal child in other ways than the matter of vigor, con- 
sequently is not able to endure the pressure incident to delivery and we 
have a still-birth. It is a question whether or not many of the hydro- 
cephalic heads found at the time of labor do not owe their origin to the 
uraemia and dropsy resulting from the albuminuria of pnegnancy. 

The same idea is applicable to the state of the placenta and to that 
of the umbilical cord at delivery. Is not the easy tearing of the cord and 
placenta sometimes due to albuminuria ? Is the waxy and the fatty 
degeneration of the placenta in any way dependent upon it ? 

Should premature labor be brought about, or should gestation go on 
to full term, after delivery the recovery is sometimes slow even under 
proper treatment. Uraemic convulsions may occur at this period, even 
if the patient has escaped them to this time. Albuminuria is sometimes 
due to a constitutional tendency to renal difficulties. Such tendencies 
may be awakened by the irritation and congestion of the kidneys caused 
by the mere presence of the foetus in utero, or from the pressure of 
the gravid yterus upon the renal vessels. Albuminuria does not 
necessarily imply structural changes in the kidneys, but the greater the 
quantity of albumen the greater the probability of renal disease. If 
the albuminuria has been slight and there have been no structural 
changes, under proper treatment the oedema, headache and dyspnoea 
are relieved, the blood gradually resumes its normal condition and the 
debility, nervous prostrations, anaemia and albumen disappear. If 
the attack has been marked and persistent during recovery, the symp- 
toms are relieved gradually, the urine becomes normal in quantity and 
color, the casts and albumen become less, and finally we have proper 
urine. There is a general law which applies to blood distribution, 

Bureau of Obstetrics. 49 

velocity and pressure in all parts of the organism, which has not in the 
past been sufficiently emphasized. It is that there is a normal — a 
physiological — blood supply, pressing and " waste," varying according 
to the part under consideration, and that if either of these factors be 
persistently augmented or diminished, a pathological cell action results, 
function and repair may be stopped and degeneration of tissue result. 
Congestion of the kidneys may be active or passive. In the former 
instance an undue amount of blood is sent to the kidneys. As a con- 
sequence of such persistent action, not only is the physiological status, 
so far as the secretion of the urine is concerned, interfered with, but 
the arteries are distended, the blood filters through their walls, both 
the afferent and efferent vessels, the glomeruli, malpighian bodies and 
tubuli uriniferi are filled with broken down blood globules, epithelium 
and debris ; the kidneys are la^ge and soft, and a longitudinal section 
shows them to be of dark chocolate color, filled with blood and having 
many hemorrhagic spots. A change of tissue follows and we have one 
of the forms of Bright's disease as a result. Total suppression of renal 
circulation produces gangrene of its tissues. 

The passive congestion does not come from the increased supply of 
arterial blood, but is owing to the pressure of the gravid uterus upon 
the renal veins. The escape of the blood from the kidneys is thus 
impeded, the walls of the veins near the point of infarct are distended 
by the pressure behind, the continued and extended pressure causes the 
distension to extend further on, until the walls of the veins of the kid- 
ney are more or less involved. As a result, we have, as in the preced- 
ing case, a filtering of the blood or its albumen through the distended 
vascular walls. In this case, however, the efferent vessels are more 
especially involved. If the obstruction to the venous circulation be not 
extensive and not persistent, we find albumen in the urine, or we 
may have albumen, blood globules and casts (fibroid cylinders). 

If the pressure be marked and long continued, the renal blood vessels, 
malpighian bodies and the tubules become filled with -blood globules, 
epithelium and fibrinous casts. There is uraemic poisoning. The kid- 
neys are engorged with blood, are enlarged, and of a brownish or 
purplish hue. Hemorrhages takes place in both the cortical and the 
medullary portions. Fatty degeneration and decay may result if the 
venous stasis continue for sometime. 

It will thus be seen that the condition of the woman who has had 
albuminuria during pregnancy, after her delivery, is a variable one. If 
the albuminuria has been slight and there have been no structural 
changes so far as the kidneys are concerned, the effects are compara- 


little moment, if however, there has been a large quantity of 
and the changes in the renal tissues which usually accompany 
mdition have been present, the effects, I might say the prog- 
neh a condition is to be governed almost entirely by the degree 
ature of the degeneration of the tissues of the kidneys. To 
2ast, in many of these latter cases, complete recovery is 


By Geokge W. Winterbdrn, M. D. 

■e of this complication of pregnacy is often difficult, and in 
i seems impossible. Nevertheless it is rare that the properly 
imedy fails to benefit, to some degree, and in many cases all 
nal symptoms disappear, including the albuminous quality of 

bed has been found a very important factor in the treat- 
many cases, where the proportion of albumen is as high as 
•or cent., the continuous recumbent position, without other 
the surroundings of the patient, or any change in her diet, 
)d the percentage of albumen nearly one-half. Mental rest 
rtant as physical, and unless the patient can be kept from 
. undue nervous excitement, no very decided results can be 
Tom the medicinal treatment. The patient's skin should be 
, and thus as much of the depuratory work of the system 
led through it as possible. This cleanliness may be secured 
ily sponging with alkalized warm water. I have sent sev- 
its to the Turkish bath with manifest advantage to them- 
; this measure is impractical in a vast majority of cases, and 
except where the attendants are known to be carefnl and 

[ should be largely liquid, and if the patient can be restricted 
liet, all the better. The patient may be encouraged to drink 
^lysmicorBethesda water. If these do no other good, they 

Bureau of Obstetrics. 51 

at least flush the tubules of the kidney and wash out obstructions. 
Large meals are an objection, and while the patient need not be put on 
what is styled a low diet, it is better to take food in small qnantities at 
more frequent intervals. Light-weight flannels should be worn next 
to the skin, and changed night and morning ; this is very important. 
Exposure to inclement weather, draughts, etc., must be avoided, as a 
suppression of the natural exhalation from the skin is sure to be fol- 
lowed by an increase in the percentage of albumen in the urine. 

The selection of the remedy homoeopathic to the case is not easy. 
The symptom " albumen in the urine " is of little service, as most of 
the drugs which have been used to cure this condition have never been 
proven to possess this characteristic in their pathogenesy, and many 
remedies which might be called for in albuminuria from other causes 
would not be demanded here. We should hardly look to Crotalus, 
Aurum, Nitric or Benzoic acid, or to Phosphorus in the albuminuria 
of pregnancy, although these have all been found of the greatest clini- 
cal service in cases where the urine was albuminous. 

Among the remedies to which we may look for help in these cases 
are : 

Kalmia latifolia. Hering's proving contains only the symptom: 
Frequent micturation- of large quantities of yellow urine. But clini- 
cal experience shows it to be an admirable remedy in albuminuria. In 
women of a rheumatic diathesis, or with functional disturbance of the 
heart, Kalmia would be a possible remedy. It is regrettable that we 
have no clear indications for this remedy, but the relief of the head 
symptoms on lying down is characteristic, as is also a sense of weakness 
and weariness in all the muscles, with irregular pains ( pains come on 
at indefinite intervals, and change from place to place). The power 
of Kalmia, in many cases, is not doubtful, and I have seen it reduce 
the albumen in the urine in a few days from 20 per cent, to an almost 
inappreciable amount; and in all cases, unless /some other remedy 
should seem to be particularly indicated by the concomitant symptoms, 
I should tr} r Kalmia first. 

Another very hopeful remedy in these cases is : 

Helonias. The patient is apt to be melancholic and irritable. The 
gastric functions are disturbed, there is numbness of the lower ex- 
tremities, and burning pain in the small of the back as if the kidneys 
were two little bags of hot water, but the patient isn't half as sick as 
she thinks she is. If with albuminuria there is this tendency to 
magnify her ailments, a tendency which passes away if her interest 
can be aroused in subjects ulterior to herself, Helonias is likely to ini- 

Bureau of Obstetrics. 

uality of the urine, as well as remove the morbid condition 
Helonias is a valuable remedy in the treatment of diseases 
; origin. 

nite often the homoeopathic remedy because of the tendency 
spsy. It will be demanded when there is oedema of the 
of the hands, of the face, or of other parts. Very great 
the neck of the bladder, with frequent, painful urination 
characteristic. So is drowsiness without ability to sleep on 
a peculiar nervous restlessness. Apis is said to be an un- 
' in cases liable to abortion. 

bonioum is frequently suitable in anaemic cases with a very 
There is generally a very severe pain in the back, and, 
local cedemte. There is intense thirst (contra Apis.) i 

medies to be consulted are in the order of probably adapt- 
pocynum can., Terebinthina, Cantharis, Arsenicum, Mer- 
and Hepar sulph., though in every case the remedy will 
elected, not for the albuminuria, bnt for the general symp- 


R. C. Moffat, M. D. 


reporting a perplexing case of parturition just as the inei- 
: birth presented themselves. My object is to show that 
ion of unusual phenomena is not as easy as our text-books, 
tly our lecturers state them to be. 

myself from the imputation of inexperience, let me state 
actice is of forty years duration, and covers a personal 
y for over 1,000 births. 

— , aet. 33, in perfect health and physique, went through 
rturition successfully, and from all customary modes of 
expected her second on the 9th of February last She had 
iow " a week or ten days before that date, and except one 
irrences of the same sign, nothing occurred for a month. 

Bureau of Obstetrics 53 

On the J Oth oi March I was asked to make an examination. The 
cervix was nearly absorbed ; the os, patulous ; and within I recognized 
a sof t body that suggested placenta prsevia. My report to the hus- 
band was simply, " she has mistaken her reckoning — she will want me 
in a day or two," but having the show in mind, my expectation was — 
a lively time from a placenta over the mouth of the womb — probably* 

The next day I was summoned. She had been four hours in easy 
labor when I arrived at her bedside and made examination. The os 
was well opened, and there was no difficulty in recognizing within the 
bag of waters — a foot ! So of course I had a footling case, and my 
only difficulty would be in the safe delivery of the head. But was it 
afoot? Let me examine again. Yes, there were the proper length 
and shape of a foot, handled from below. It was broad and flat at one 
end and narrower and harder at the other. I could not indeed deter, 
mine the toes, nor as yet the ankle. However the waters had not yet 
broken and I must wait. 

There was no hemorrhage, so the placenta praevia passed out of my 
mind. The os enlarged and the waters broke. Examination renewed. 

Now, there projected a soft pulpy mass, firm during a pain, less so 
in the interval, that suggested the nates, or at least one side of them. 
Where was the foot ? Gone ! Nothing like a foot there now, and the 
examination was extended. 

It seemed marvelously like a breech ; I could make out one of the 
nates, what would pass for the sulcus, and the nates of the other side, 
but I found also a portion of covered bone, hard and sharp, that might 
(and should) be the tuberosity of the ischium. But the bone was long 
and sharp, a curved edge, not a blunt point, and an edge that extended 
further than I could reach. That did not answer to the blunt tuber of 
the ischium ! What is there in the body of the foetus like it? Not 
the ramus of the ischium ? Not the crest of the ilium ? No, there 
was nothing. I examined again, both in the intervals and during the 
pains, and could only find what it was not It was not a cheek and 
shoulder, nor a flexed thigh and calf. It must be the nates, for I could 
feel the bottom of the sulcus, and in the crowded condition of the 
parts, this best answered the indications. I could wait, however, for 
the condition of the patient was excellent. 

And in waiting new perplexities presented. As the foetus descended 
I could extend the examination, and I found just beyond the nates and 
the bony edge, what, examined by itself, seemed to be an ear. But 
was it not a testicle ? Hardly, it was too flat, it felt like the helix and 
anthelix, and by crowding the touch, something like the junction of 

Bureau of Obstetrics. 

ie head. But was it a head ? Not like anx other head I 
t. Now a testicle, whether hard or soft, ought to be round 
) — this was thick and flat. Somehow it was an ear and no 
I I rested in that conclusion, especially as extending my 
ind another just like it — and two testicles do not happen 
in proximity with one breech. Here again I must wait, 
u'le I was able to extend my finger beyond the ear, or tes- 
ter it was, and to reach the groin, if it was the groin, over 
;er. Making a blunt hook of my finger, I made steady 
h each pain and held what I got in the interval. 
'elous how intelligent the educated finger is in explorations 
sight ! Whether it be in the throat, the vagina, the rectum, 
How it supplements the eye ! Here, by feeling side- 
be finger, I recognized the thigh on one side and the abdo- 
foetus on the other, and I had only to wait and make trac- 
birth proceeded steadily and I received in my hands— an 
tale child ! 

easy now ; my " nates " was the engorged and protruded 
in situ by its enveloping membranes. I recognized my 

was a large mass, perhaps a clot of blood lying in the 

sinus ; my " testicles " were veritable ears, and my "groin" 

the child's neck. 


By H. J. Piekkok, M. I). 


ind Tarnier divide dystocia (with respect to its cause) into 

e rendered difficult, dangerous or impossible by an exces 
3f the expulsive forces. 

e rendered difficult, dangerous or impossible by obstacles to 
>n of the foetus. 

Bureau of Obstetrics. 55 

3. Those complicated by accidents liable to endanger the life or 
health of the mother and child. 

Of these causes I shall speak mainly with respect to the second, in- 
asmuch as the subject of this paper is pelvic dystocia. 

Pelvic Dystocia. — Labor rendered difficult, dangerous or impossible 
from some distortion of the pelvis. 

You all know what is given in the text books as the average meas- 
urements of a well formed female pelvis; but, judging from the 
various authorities, it is by no means settled how much variation from 
these generally accepted figures is necessary to constitute a malformed 

Anywhere from two lines to Cazeaux's definition, which is "any 
pelvis which from excessive size or narrowness is capable of producing 
notable difficulties in the exercise of the puerperal function," — being 
given as distorted. 

It seems to me that Cazeaux's definition is the moBt rational and, 
adopting this definition, 1 also adopt his classification which divides 
the subject into two heads : 

Distortion by excess of amplitude. 

Distortion by excess of retraction. 

The first is important only as exposing the woman to all the dangers 
of a too rapid labor by allowing the voluntary muscles to act before the 
dilitation of the os is accomplished and the bony walls not being close 
enough to support the womb, the whole mass is brought down ; or the 
lack of obstruction at the straits allows of the expulsion of the child 
before the os is dilated and produces a severe laceration. The condi- 
tion is one easily managed as far as the delivery is concerned if the 
fact of there being too large a pelvis is known in time. 

The second, however, is not this simple state of affairs, for the 
existence of a retracted pelvis is one of the most serious conditions met 
with in the course of a labor. 

There are two forms of this : 

The simple contracted pelvis without curvature or malformation of 
the bones (absolute contraction of Velpeau) and the contracted pelvis 
by the curvature and malformation of the bones (relative contraction 
of Yelpeau). 

In respect to the first there is little to be said. It is a condition 
that has only been recently admitted as a separate variety; in the 
earlier classical works it is not mentioned at all, as at the time they 
were written, it was not supposed that a pelvis could be relatively small 
in all directions without some bony malformation. 


56 Bureau of Obstetrics. 

It is a condition that is impossible of diagnosis except by local 

The second relative contraction of Valpeau, is the common form 
of pelvic distortion, to which there are in general four assignable 

1. Deformation from rachitis. 

2. Deformation from osteomalacia. 

3. The oblique oval pelvis. 

4. Deformation consecutive to a previous deformity of some other 
part of the skeleton. 

In considering these causes separately (and in passing it might be 
as well to say that the cause of the absolute contraction seems to be 
simply a freak of nature, the same as a disproportionately large head 
or an exceptionally small limb,) it is found that the first, " rachitis, " 
deforms the pelvis by altering the shape of the bones and by arrest- 
ing their development. The most important alteration in a rachitic 
pelvis is: The antero-posterior diameter of the superior strait is 
always shortened and usually the oblique is the same. Transverse less 
frequently — sometimes normal — or even lengthened. 

The sacrum is less curved. The diameters of the inferior strait 
are usually normal, except in a small proportion of cases, where they are 

Deformity by Osteomalacia. — This, like rachitis, by softening the 
bones diminishes their power of resistance, but it differs from the first 
in that it appears only in adults and not in infancy and often occurs 
after a woman has had one or two children. 

The softening of the bones in osteomalacia is generally greater 
than in rachitis, hence the pelvis is often much more deformed. 

The deformity is usually the contraction of the lateral parts and a 
projection of the pubic symphysis. The iliac fossae are crowded 
inwards. The sacrum is much more curved. The inferior strait more 
deformed than the superior 6trait, all its diameters being altered — viz : 
shortened. But more especially is there a considerable approximation 
of the tuberosities of the ischia and of the ischia-pubic rami. 

According to Dr. Harris osteo-malacia is rarely met with in this 
country, it having been observed in the United States only in a few 
isolated cases. 

The Oblique Oval Pelvis. — This variety was first described by M. 
Nseg^le as the oblique contraction. Its principal characteristics are a 
perfect fusion of the sacrum with one of the iliac bones. 

Displacement of sacrum to anchylosed side. 


Displacement of symphysis to healthy side. 

Malformations dependent upon a previous deformity of another part 
of the skeleton. 

Those that affect the form and position of the pelvis most are : 
Deviations of the vertebral column, congenital and non-congenital 
luxations of the femur, lesions of the inferior extremity, contu- 
sions of the dorsal region during childhood. 

Of course the effect of these conditions on parturition is known and 
apparent to all — inasmuch as the narrowing of the canals and the 
placing of bony obstacles in its way can but hinder the expulsion of 
the child ; though it is to be remembered that these effects are not 
absolute, but merely apply to a majority of the cases, inasmuch as so 
many factors influence the mechanism of labor. For example, where 
a pelvis is very much contracted we may be fortunate enough to find 
a very small child or a particularly mobile head, or a symphysis that 
yields to a remarkable degree, thus allowing of a spontaneous delivery. 
However, as these conditions are not discoverable until the child is 
born, it still leaves the necessity of being prepared with some course 
of treatment independent of the help that may be afforded by nature. 

The generally accepted scale of measurements (as all obstetricians 
give about the same) which will determine what class of procedure it 
will be necessary to adopt is : 

1. A pelvis which at its contracted part has an opening of 3£ 
inches — all diameters. 

In this class, labor is apt to be slow but a spontaneous delivery may 
be reasonably expected. 

2. Where one or more diameters have an opening of 3£ inches as 
a maximum and 2£ as a minimum. 

In pelvis of this minimum measurement (2^ inches at contracted 
part) a spontaneous expulsion of the foetus is barely possible. In a 
large majority of the cases, outside aid is required, unless the head is 
preternaturally small, or is reducible to a large extent or unless the 
bones are softened by putrifaction or lack of development. 

3. Where the narrowest point is under 2£ inches. 

This condition almost invariably precludes, so rare has been the 
exception, a natural delivery, (there being, so far as I can learn, but two 
substantiated cases on record where delivery was successfully accom- 
plished and the pelvis measured under this limit. In these the pelvis 
was 2i inches at its narrowed point) and there is no alternative but to 

;r< .. 

|j|y. 5ft »' Bureau of Obstetrics. 

| '■ * '}' either enlarge the passage, diminish the bulk of, or provide a new place 
rV of exit for the child. 


ffiiff' The weans of diagnosis of these hindrances to a successful labor are 
jfc substantially as follows : 

O0$rY. Rational signs, or as I understand it, subjective symptoms : First, 

a most minute inquiry into the early history of the patient, particu- 
larly as to all the accidents which befell her during infancy, the age at 
which she first began to walk, whether standing in the erect position 
was possible or easy in early years, or after having walked well she 
i was afterwards afflicted with any weakness in the lower extremities. 
*?&",: If there is any present curvature of either the spine or limbfe, or of 
fy both, and if there is such curvature the period at which it appeared, 

a ;^ • and if the curvature is of both the spine and limbs, whether that of 
^ ' the lower extremity preceded or followed that of the spine ? 

'. * •• 

If she limps ascertain carefully the cause, see if it proceeds from a 
y shortening of the limb, or atrophy of one limb, or whether it is due 

to a flattening of the anterolateral walls of the pelvis, or an old or 
i\ recent affection of the ilio-femoral articulation, or a spontaneous or 

> congenital luxation followed by the permanent displacement of the 

head of the femur, or whether upon an old and imperfectly consoli- 
dated fracture. 


Inasmuch as the two principal deformities of the skeleton are 
from rachitis or spinal curvature, the above minute history and 
examination is decidedly important, because in the first the pelvis is 
almost certain to be deformed, while in the latter it may be perfectly 
normal. In rachitis the deformity, as you know, is especially in the 
long bones, and the short stature usually seen is due to the arrested 
development and curvature of the long bones, and the pelvis descends 
with them as well as partaking in the general osseous trouble. 

While in the case of spinal curvature the long bones being normal 
as to development the pelvis is held in its natural position ; the stunted 
appearance of the woman being due to the folding together of the 
spinal column. 

Again, this history of the early years or months is important because 
modern pathological research has shown that rachitis, properly so 
called, is a disease almost exclusively confined to infancy, though it is 
seldom observed in the infant at term, usually beginning at about the 
eighteenth or twentieth month and rare after puberty. 


r ; 

Bureau of Obstetrics. '5d 

A prominent Parisian authority says that in 386 cases, of which he 
has the history, the invasion was : 

Before birth 3 cases. 

First year 98 " 

Second year 176 " 

Third year 35 " 

Fourth year 19 " 

Fifth year 50 •< 

Sixth to twelfth year 5 " 

m Total 386 cases. 

From these and more, reported by Bouvier, Ruff and others, it seems 
to be settled that deformities occuring in infancy are nearly always of 
a rickety nature, and to quote from M. Jules Guerin : " We may 
exclude rachitis in all varieties of softening that take place in adult 
bones, and all deformities occurring exclusively in young girls at or 
about puberty." And he goes on to say "if the cause of the 
deformity can be traced to a period of life before puberty, and 
especially if the deformity has made its appearance from below 
upwards it is rachitis, and the almost certain probability is a deformed 
pelvis." The spread of the deformity from below upwards is a symp- 
tom that is concurred in by all the leading orthopedists of the Old 
World as being indicative of rachitis. This same authority affirms 
that the deformity is due to osteomalacia if the following conditions 
have been exhibited : In all cases where the deformity occurs after 
the adult period of life had been reached, and especially if it followed 
one or two successful confinements, and also if the patient has. had 
symptoms of acute softening. 

The next are the sensible signs, that is mensuration of the pelvis. 
This is both external and internal (external and internal pelvimetry). 

The only thing to be said in respect to it is that the following are 
the average measurements of a well formed pelvis : 

1. From anterior inferior spinous process of one ilium to same 
point on the opposite side, 8£ inches. 

2. From anterior superior spinous process of one side to same 
point on the other, 9£ inches. 

3. From middle of iliac crest on one side to same point opposite, 
10£ inches. 

4. From the middle of iliac crest to tuber-ischii, 7£ inches. 

The superior strait divides this distance into two equal parts, whence 
the lateral portions of the greater or lesser pelvis are each 3J inches. 




1 1»:'- 

60 Bureau of Obstetrics. 

5. From the anterior superior part of the symphysis pubis to the 
apex of the first spinous process of the sacrum, 7£ inches. 

From which 2£ inches are to be deducted for the thickness of the 
base of the sacrum and i inch for that of the symphysis, leaving for 
the sacro-pubic interval, 4J inches. 

6. From the tuber-ischii of one side to the posterior superior spin- 
ous process of the opposite ilium in an ordinary pelvis is, 7 inches. 

7. From anterior superior spine on one side to posterior superior 
spine on the other side — mean 8J inches. 

8. From spinous process of last lumbar vertebra to the anterior 
superior iliac spine of either side, 7 inches. 

9. From trochanter major of one side to the posterior superior 
spinous process of the opposite side, 9 inches. 

10. From the middle of the lower border of the symphysis pubis 
to the posterior superior spinous process on either side, 6f inches. 

The above are the measurements. They are good if you can get 
them, but I find that it is considered no easy task to make these exact 
measurements. There have been a number of pelvimeters invented, 
but they are all unsatisfactory, owing to the extreme difficulty of using 
them and their liability to mislead. The ordinary digital examination 
is the surest and safest plan. 

In a digital examination the anterior, posterior and lateral walls of 
the pelvis are comparatively easy of examination, and this is very fre- 
quently sufficient. 

Indications for Treatment : The procedure to be followed when 
the pelvis measures at its most contracted part 3} inches. First, vertex 
presentation — spontaneous delivery possible. It is said to wait about 
eight hours after the membranes have given way and the os is fully 
dilated (unless some accident dangerous to mother or child occurs, or 
the feebleness of the pains indicate different,) and then apply forceps. 
Pelvic presentation,. — Make traction and apply the forceps some- 
what earlier. Face. — Convert to vertex and apply forceps at once. 
Trunk. — Treatment differs according to stage of labor. If the con- 
traction is discovered before the membranes are ruptured (or very 
shortly after) and the foetus is very movable, the conversion of the 
presentation of the shoulder to one of the vertex should be made 
and then leave the rest to the expulsive forces of nature, but after 
the waters are discharged the contraction of the womb renders the 
introduction of the hand and cephalic version difficult, and it is 
better to turn by the feet. 

Of course the certainty of the child's being dead would alter this, 



as pelvic version would be easier for the mother. Cephalic version 
being recommended on account of its being safer for the child ; 
second degree of contraction — 3f greatest, 2J shortest. 

If the foetus dies before or during labor and the uterine contractions 
are unequal to the task of expulsion the dangers of delay are so great 
that it is best to perform embryotomy and the application of the 
ordinary or embryotomy forceps. 

If, however, the membranes have broken and the water partially or 
wholly evacuated, and the uterine contractions are exerted on the 
child's body alone, and repeated endeavors have been made to extricate 
the child without success, it is deemed by some to be admissible to 
attempt pelvic version, and thus try, if there is any reason to believe 
the child is still alive, to deliver it still breathing. However, thte 
majority of the writers advise craniotomy. 

Pelvis under 2£ inches. There have been two cases reported by a 
French obstetrician in which delivery was safely accomplished where 
the longest measurement was 2J inches. From the fact, however, that 
there has been but these two isolated instances reported it may be as 
well to leave them out of consideration as having any bearing on the 
general rule, which is that delivery unaided is practically impossible, 
and the choice where the pelvis is under 2£ inches being between 
embryotomy — Cesarean section-— Porro's or Muller's or Veit's modi- 
fication or laparo-elytrotomy. 

If the child is dead embryotomy is to be tried first, or if the child 
is still alive and it is decided that it is advisable to risk the mother's 
life to the the extent of an abdominal section it is to be decided which 
of the others shall be attempted. 

The indications for Caesarean section are crainotomy and version 
unsuccessful — pelvic contraction — solid tumors encroaching upon the 
pelvic space. Advanced carcinomatous degeneration of the cervix. 
If the mother is moribund and the child known to be alive and the 
rapid delivery by the natural passages is impossible. Or it may be 
undertaken at the mother's request if otherwise delivery cannot be 
accomplished without the sacrifice of the child. 

Lusk says, in his chapter on this subject, that the great objection to 
Csesarean section is that the results are entirely dependent on the 
amount of uterine contraction subsequent to the operation. He says: 
When the operation is performed early in labor and the pains are well 
established and yet the patient's strength is not exhausted and the 
sutures are introduced, art has done all it can, and then if there is 
imperfect contraction of the uterus or a cutting out of the sutures, it 

•:v- ' • *♦ 

•. * 


f r 62 Bureau of Obstetrics. 

{f : .V leaves an open communication between the uterus and the abdominal 

~V cavities ; and as the uterine section itself is apt to excite a considerable 

X : ] degree of catarrhal endometritis, and as the admission of air into the 

uterus furnishes the condition for the decomposing of the lochia, it 
» folio ws that the patient is always exposed to the dangers arising from 

penetration of septic materials into the peritoneal 6ac. One of the 
most important advantages claimed for laparo-elytrotomy is that the 
incision is made into the walls of the abdomen in a line of Pouparts 
ligament, lifting the peritoneum and dissecting down to the vagina, 
dividing it (the vagina) transversly, and then having reached the 
cervix extracting the child through the cervix and accomplishing deliv- 
ery through this artificially-made opening, and thus avoid entering the 
peritoneum or wounding the uterus. At this point is one of the chief 
objections to this operation, because, in order to bring the child through 
the cervicel canal, labor must have actually begun, and in fact be 
pretty well advanced, for the reason that the os uteri mu6t be dilated 
to a considerable extent to accomplish it. To quote again from Dr. 
Luek's work on Obstetrics, " The operation should not be undertaken 
unless it is certain that the dilatability of the cervix is such as to allow 
delivery by forceps or version, after the artificial canal is formed, to be 
. accomplished with ease and certainty." Statistics of the five opera- 
tions, Caesarean section, Porro's, Muller's and Veit's modifications and 
gastro-elytrotomy show an advantage for the latter three as against the 
first, Muller's modifications having a smaller percentage of deaths than 

Dr. Harris giving the following : Caesarean section — general mor. 
tality, sixty per cent., and in Great Britain eighty-one per cent. 

Up to this time, 1886, Veit's operation shows a general mortality of 
nearly seventy-one and a half per cent. 

Up to March, 1885, there have been forty-two operations by the Mnl- 
ler modification, with twenty-one mothers and thirty-one children 

By the original Porro method, one hundred and nine operations, 
saving forty-six mothers and eighty-five children. 

The results so far with Thomas' operation give it a better record 
than any of these, but as this operation is so new and the number of 
times it has been performed so few, in comparison with the others, it 
is unsafe to base any positive judgment upon it, for the next few 
operations might either still further increase its good record or place 
it below even Caesarean section. There have been four modifications 
of Caesarean section proposed, (all originating in Germany) which 


Bureau of Obstetrics. 63 

endeavor to lessen the mortality, but the success of these h%3 not been 
very great. 

Dr. H. J. Garrigues, in quite a long and exhaustive article in the 
American Journal of Obstetrics, compares gastro-elytrotomy with 
Aophora-hysterectomy and arrives at the following conclusions : 

1st. That Dr. Thomas' method of gastro-elytrotomy has been per- 
formed eight times (this article was written in 1883, since which there 
have been, I think, three operations,) saving one half of the mothers 
and all the children except two that had died long before the operation 
was performed. Thus the percentage of recoveries was as good as in 
the best of the other operations. 

2d. The operation may be performed with many antiseptic precau- 

This is given in answer to that which has been more of a fear than 
actual objection to this operation, namely, the impossibility of operat- 
ing with strict Li6terism. Though this is true and antiseptic surgery 
cannot be carried out completely, yet many antiseptic precautions may 
be taken, by the careful disinfecting of the patient and all the partici- 
pants in the operation, as well as all the instruments, and a free use of 
Carbolic injections and dressings. 

3d. Porro's operation has given less good results and Muller's no bet- 
ter than gastro-elytrotomy. 

4th. The dangers, especially as regards hemorrhage — peritonitis and 
septicemia are greater in Porro's and Muller's operations. 

Hemorrhage would be less in Thoma?' operation, for the reason that 
the uterus is unharmed in this case, while in the old operation the 
incision was made into the uterus, and besides the necessary hemor- 
rhage, there was the liability of entering the uterine sinuses. Porro 
endeavored to lessen the liability to hemorrhage and also to septicemia, 
by, after emptying the uterus of its contents, ligating it at the neck and 
amputating it just above the internal os, then bringing the stump out 
and fixing it at the lower angle of the external wound, thus making 
the treatment of the 6tump extra-peritoneal. Muller thought to 
improve it by bringing the uterus out of the abdomen before opening 
it (the uterus) and evacuating its contents. Prof. Veit's operation was 
the same, except the treatment of the stump was intra-peritoneal. 

In respect to peritonitis the danger would be less, because the per- 
itoneum is unharmed. The diminished liability to septicemia has 
already been spoken of. 

5th. The intra-peritoneal treatment of the stump in Veit's modifica- 
tion carried out in five cases has four times resulted in death. 

Iff.* / ^ ',. A. ; »• 

■Ms , '• 


64 Bureau ofr Obstetrics. 

6th. One advantage of the Porro-Muller operation is the possibility 
of operating before the commencement of labor. 

It is true that oophorohysterectomy can be performed before the 
dilitation of the os has begun, and thus the operator may choose his 
own or the best time, do it at leisure, and the patient will not have lost 
strength by efforts at delivery through the natural passages. 

Though this is in favor of either Cesarean section or its modifica- 
tions, it must be remembered that it is quite seldom that the case is 
brought to the notice of the surgeon very long before delivery begins. 

7th. Gastro-elytrotomy is less repulsive to the mind of the patient, less 
difficult of execution, and can be performed with less assistance than 
the Porro-Muller or Veit's operation. 

It is said that gastro-elytrotomy can be performed by the ^operator 
and one assistant, the latter to give the anaesthetic. 

8th. It does not sterilize the woman. 

Most all of those who have written upon the subject agreeing that 
the operation can be performed two or even three times upon the same 

9th. In country practice the old-fashioned operation of Caesarean 
section will in most cases be preferable to all its substitutes. 

This because it requires so little assistance and can be done with 
any ordinary cutting instrument. There being records of cases being 
operated on with a common razor. 

10th. Thomas' operation can be performed on the left side as well as 
the right. 

11th. The ureter stays below the incision and is out of danger. 

12th. All those who have performed gastro-elytrotomy on the living 
subject or on the cadaver recommend it. 

There are three points I should have mentioned when speaking of 
Dr. Garrigues' fourth conclusion, viz : the difference in danger between 
the two forms of operating. They are the danger of septic-peritonitis 
and septicaemia when the foetus is dead and the liquor amnii fetid, 
when of course the danger of the above would be much greater with 
the operations that open the uterus, and the dangers of shock and 
exhaustion. The danger of the former (shock) is greater in the older 
operations, but the danger from exhaustion from the suppuration is 
decidedly more in Thomas' operation ; at the same time there have been 
no deaths from this cause, either because the patient has not lived to 
reach that stage, or the careful attention to cleansing the parts and a 
free use of Carbolic acid has prevented any untoward result. 



» r 

Bureau of Obstetrics. 65 

Most all of what I have said has a favorable bearing towards the 
operation of Dr. Thomas. 

The following are some of the counter indications to it : 

One. — The impaction of the head in the pelvis. 

Two. — Pressure of a large tumor in the vagina. 

Three. — An obstruction in the womb itself. 

Four. — Atresia or coarctation of the vagina. 

Five. — The pressure of a tumor starting from the anterior wall of 
the pelvis and pushing the vagina back towards the sacrum. 

Six. — The general condition of the patient will sometimes contra- 
indicate it. That is where the system is in such a bad condition 
that it is certain she cannot stand the loss caused by the extensive sup- 
puration consequent on gastro-elytrotomy. 

There is one other objection, which, however, is not shared in by all 
the more prominent accoucheurs who have written on the subject : 
That is the difficulty of bringing the cervix above the brim of the 
pubes to enable the operator to extract the child with the forceps or to 
perform version. 

So far I have said nothing with respect to the indications of prema- 
ture labor. Of course if a woman becomes pregnant and it is discov- 
ered that she has a contracted pelvis, the question of bringing on labor 
before time is to be decided. Cazeaux and Tarnier recommend the 
induction of premature labor at the seventh month of gestation in all 
cases where the shortest diameter of the pelvis is three and three- 
fourths, beyond this, as a rule, unsatisfactory. 

It was my intention to have gathered the opinions of the more cel- 
ebrated accoucheurs on the operation of gastro-elytrotomy, but the 
only decided remarks I can find are by Dr. Thomas Whiteside Hime, 
of Sheffield, England, who says : " Considering the easy nature of the 
operation — the certainty of saving the child and the strong probability 
of saving the mother, it is a question how far craniotomy will again be 
justifiable, and whether Caesarean section should not drop into obliv- 
ion." And Dr. Edis, of London, says : " The operation of laparo- 
elytrotomy will supercede that of Cesarean section, and also in many 
instances that of cephalotripsy." 

Most of the other obstetricians of note practically unite in saying, 
wait and see what results the future will bring forth. 




Drs. Walter Y. Cowl, Chairman, - - New York City. 

Henry Minton, Brooklyn. 

C. S. Macy, New York Citv. 

Amelia H. Wright, .... New York City. 

George Allen, .... Waterville. 


By W. Y. Cowl, M. D. 


At the meeting of this Society in Brooklyn in 1881, it was my priv- 
ilege to read a contribution upon " Tight Lacing," and the various 
disorders that may result therefrom. 

The number, the variety and the severity of the affections which 
such a constriction of the waist with compression of theabdomen and 
lower chest, either favor or determine, was found to be considerable. 

The compression that the term u Tight Lacing " implies, was viewed 
as restrictive of both the motions of the body and the movements of 
respiration and of peristalsis. This restriction is evident to anyone who 
has had an abdominal bandage tightly applied, and its effects upon the 
performance and health of the parte compressed is to be readily 

It is apparent that while constriction of the waist hinders the flow 
of blood in the veins of the lower half of the body towards the heart, 
and begets or favors disorders of the rectum and other pelvic organs, 
compression of the abdomen and freer part of the chest prevents the 

♦Read by title. 

Bureau of Gynecology. 67 

proper expansion of the lungs — both laterally and vertically — upon 
which the purity of the blood depends, checks the corresponding 
motion of the abdominal organs, which nominally, without doubt, aid 
their slow circulation, especially in the liver, and obviously interferes 
with the comparatively weak and involuntary contractions of the 
stomach and intestines upon which digestion depends. 

An idea of the nature and importance of these movements is to be 
gathered from observation of an animal, such as a rabbit, which has a 
lax abdomen, and is mainly dependent upon diaphragmatic respiration. 
The abdominal wall, especially at the epigastrium, is seen to rise with 
each inspiration and sink again upon expiration, while waves of peris- 
talsis from time to time distinctly pass ovfer portions of its surface. 
During normal quiet respiration the chest does not appreciably 
expand, and the free border of the ribs, especially in young 
animals, is drawn inward upon inspiration by the contraction of 
the diaphragm. 

These respiratory morements are reversed when the diaphragm is 
paralyzed by cutting or excising a portion of the phrenic nerves 
below the cervical plexi. The inspiration becomes laboriously thoracic 
and is accompanied by a raising and flaring of the free borders of the 
ribs, while the epigastrium sinks. Adult animals survive but for a lim- 
ited period. Younger ones may live indefinitely, sustained solely by 
thoracic respiration. 

The movement of the chest in this instance is much more appar- 
ent than the abdominal movement it replaces, for the reason that the 
abdomen is much greater in size than the chest. 

To revert now to man : We are well aware that in his normal condi- 
tion he has not the predominant abdomen of the lower herbivora, yet 
he does possess a well-developed diaphragm, and this implies the health- 
ful *necessity of a greater or lesser amount of abdominal respiration, 
according to the conditions of the individual. 

But his greater expanse of chest over abdomen, his free and upright 
position, the severe conditions of the circulation requiring an aspira- 
tion of blood to the chest, the thickness of the abdominal wall, together 
with the universal preference of workmen for a belt and as light 
clothing of the chest as the conditions will allow, all show plainly the 
predominance of costal respiration in man. 

We say in man, for, although with womankind there has always been 
a greater preference for a belt and freedom of the shoulders, and 
whilst they frequently present a greater amount of apparent expansion 
of the upper chest, the usual statement that " in man the respiration 

68 Bureau of Gynaecology. 

is more abdominal, and in woman more costal," is both untrue and mis- 

The vital capacity of man is much greater, (by German statistics 3:2) 
his bony chest is larger, his expansion is greater, and his abdominal 
movement on respiration is also less than that of the chest. 

It is evidently and chiefly because of the lesser development of the 
chest in woman that its motions are more apparent than in man. The 
greater softness of its tissues likewise favors the greater play of the 
upper ribs, which both permits and is exaggerated by a compression 
of the lower chest from a corset. 

But we have made the observation that those who have a greater 
necessity for free respiration preserve the custom of suspending cloth- 
ing from the waist, leaving the shoulders freed from weight and the 
chest unconstricted. 

It is on the other hand easy to perceive that both braces and stays, 
corsets and suspenders, have resulted from the increasing necessities of 
individuals, because devoid of a natural waist, or whose occupations 
were so- sedentary as to render uncomfortable the constriction of the 
abdonien by a belt or tight clothing. 

These fashions, however, have now become so general and so fixed 
that they will not speedily wane, and we may leave them to time to 
correct. But the question which is often asked, respecting weakly indi- 
viduals, especially children : shall a corset— a loose corset — be worn, or 
shall the clothing be suspended from the shoulders, requires an answer. 
Let us consider the shoulders first. 

We have already remarked the predilection of those who are sensi- 
tive to their restriction for a relief from weight and a looseness of 
clothing. This is especially noticeable in sailors. Yet such a rare 
instance may lead us to doubt whether the whole matter does not well 
govern itself, and the varying costumes of people as we find them, # be 
not better than we can devise. 

There are, however, at least two considerations to the contrary ; one 
is that weight upon the shoulders, or constriction of the chest, either 
above or below, inevitably restricts respiration, whether quiet or active ; 
and the other is, that persons of a more or less sedentary life, breathing 
less air, breathing much indoor air and having from less action a slower 
circulation, should be rid of all embarrassment to respiration possible. 

It is evident that the weight of clothing upon the shoulders must be 
an embarrassment, for the mass of the shoulder itself, with the depend- 
ing arm, is only kept from pressing upon the ribs in the upright posi- 
tion by the muscles of the neck, chiefly the trapezius. Additional 


Bubeau of Gynecology. 69 

weight of clothing is then embarrassing in three ways : First, by its 
mere gravity ; Secondly, as an especial hinderance to the trapezius 
muscle upon the belly of which it largely, and in the case of sus- 
penders, mainly falls ; thirdly, by the friction of the depending cloth- 
ing in inspiration, which rapidly increases as the breathing becomes 
deeper, and of the three is, perhaps, the most active in limiting the 
respiratory movement. 

The advantage to respiration of relief from the weight of the arms 
and shoulders themselves is apparent in the raised clavicles of a patient 
in an asthmatic attack. The normal upward movement of the shoulder 
in respiration is also to be readily observed in quiet as well as active 
breathing, although it may not be apparent at a glance. 

It is a fact to be borne in mind that man is an upright animal, and 
while his free arms favor lateral expansion of the chest, tliis advan- 
tage is offset by the weight of the upper extremities as a whole, which 
press like levers upon the ribs of each side. It is, therefore, necessary 
in the positions of sitting and standing that the head shall be held 
upright to sustain the muscles of the neck, and the latter kept in con- 
traction to give the upper chest free play. To point the matter, how- 
ever, a mention need only be made of the fact that phthisis pulmonalis, 
which carries off half of all civilized adults, rarely begins except in 
the upper lobes of the lungs. 

It seems altogether then that as little clothing as possible should be 
suspended from the shoulders, and it would appear scarcely necessary 
to add that this clothing should exercise no tension upon^full expansion 
of the chest. Unfortunately, however, one may readily observe that 
modern garments do not fulfill this condition. Whilst in an erect 
position the plane of the back from arm to arm is quite flat, the chest 
in front, from arm to arm, makes a marked bow and measures about a 
quarter longer. Now in clothing made, with rare exceptions, the 
same amount of difference will not be found. This is readily per- 
ceived in the tension across the chest when an individual is requested 
to take a deep breath, whilst at the back the garment only draws when 
the shoalders are stooped. 

If, on the other hand, we examine under clothing, as sold in shops, 
it is almost universally found of the same breadth before and behind. 

In a stiff shirt such a fault becomes aggravated, and observation 
seems to afford ground for the view that round shoulders largely come 
from unfit costume. 

Our previous question remains, however : How shall clothing be 
suspended from the waist that can be so suspended 2 


1 .* » 




Bureau of Gynaecology. 

The various foregoing considerations, as well as the unwholesome- 
ness of an impervious garment, exclude a corset, and suspenders, as 
we have seen, are still worse. 

How then shall a suspensary belt be arranged for those that are 
sensitive or too stout for simple constriction at the waist ? To answer 
this let me mention the device of our colleague, Dr. Roth, of London, 
which as a means for the purpose is both sufficient and satisfactory, 
consisting of an elastic band that stretches across the back from the 
side seams of the trousers or other garment and is completed in front 
by plain cloth flaps conforming to the figure. 

In recommending this measure let me add, in conclusion, that those 
individuals who wear light clothing and few wraps depending from the 
shoulders thereby gain a certain protection against cold and changes of 
temperature, for their better respiration keeps them warmer in con- 

*A Plea for Total Extirpation of the 



A. R. Wright, M. D., 


Doubtful surgery is not generally popular. Though fully sensible 
of the delicacy of my position in advocating surgery that offers at the 
present such slight inducement to the surgeon, a desire to know of 
some more hopeful treatment of uterine cancer than the past history 
of medicine gives us, has forced me to a consideration of this subject 
Hearing of successful results of hysterectomy, after having a series 
of the fatal uterine scirrhus, one begins to doubt if he has done his 
whole duty to such patients until he has placed before them the chance 
for prolonged life through this operation. Rarely do we hear of a 
case of uterine cancer cured with medicine. I am well aware that 
many of our ardent homoeopathic presuribers claim cures of this dis- 
ease with their remedies. But I have yet to know of a single properly 
diagnosed case cured with any remedy, homoeopathic, allopathic, eclec- 
tic or specific. 

*$emi-Annual Meeting 1886. 

t . .41 

Bureau of Gynaecology. 71 

We hear, indirectly, of cures, but we cannot be assured that theie 
was a correct and positive diagnosis. 

Of all the cancer cures the Cundurango craze was the liveliest of 
our day. Yet we had not a single authenticated case of cure from this 
blissful remedy. 

Dr. G. H. Payne, of Boston, f in a very careful and intelligent article 
on the subject, first gives encouraging words for medical and local 
treatment, then follows by saying that surgical interference " is the 
only means that offers any ground for hope." Since, in the last few 
years, the operation has been such a comparative success by very many 
gynaecologists in Europe and America, we think the time has come 
for us to consider well its expediency in certain cases. In regard to 
the responsibility or decision for operating, hysterectomy for cancer 
rests on an entirely different basis from the Battey-Tait oophorectomy or 
" spaying." One is for relief from a condition not always fatal, while 
ths other is for relief from certain death. Also the moral phases of 
the two conditions differ greatly. 

What experiences of others have we to warrant us in advising this 
operation ? Schroeder says " Carcinoma uteri always presents an indi- 
cation for hysterectomy, and possible recurrence should not deter from 
its performance ; for all surgeons remove cancers regardless of their 
return." I have not been able to obtain full statistics to the present 
time, so submit these scattering reports, which give some valuable sug- 
gestions. It is well known that for the last ten or fifteen years hys- 
terectomy has been performed with gratifying success for various dis- 
eases of the uterus. What follows is all the statistics we could readily 
obtain on hysterectomy tfor uterine cancer. As early as 1879 the 
operation had been performed in Germany by Kooks, Freund, Schroeder, 
Martin, Mueller, Oishausen and Baumgartner and perhaps others. 

At that time the operations were frequent in this country, but per- 
haps more isolated than in Germany. Coming down more nearly to 
the present time we find that Brenneche has operated by total extir- 
pation for cancer eighteen times, and prefers this operation to amputa- 
tion of the cervix. H. J. Garriguesff gives a compiled report of 135 
cases of entire removal for cancer. Fritsch, of Breslau, recently 
reported nineteen cases operated on. Success, as referring to the 
return of the disease, could not be given, as the report was made only 
fifteen months after the first operation, In February, 1885, Win, 

iCarcinoma Uteri. Horn. Jour, of Obst. 
ttSee Proceedings of N. T. Obst. Soo. 

Bttkeau of Gtn-eooloqt. 

;ave to the London Obst. Society statistics of 413 cases of 
pation of the cancerous uterus. 

ie choice between the operation by abdominal section or by 
action, the following reported results are quite instructive : 
nneche's eighteen cases were all by vaginal section without a 
th. Fritsch's nineteen cases, of which only two were fatal, 
iperated par vagina m, giving a mortality of 10J per cent.] 
statistics give from 137 cases by abdominal section 99 deaths, 
tality of 72 per cent., while the remaining 276 cases by 
setion gave only 79 deaths, or a mortality of 28 per cent, 
jue's report 94 operations by abdominal section gave 70 
mortality of 74£ per cent., while 41 operations by vaginal 
ve only 12 deaths, or 29.27 per cent. 

iese results before us ought we not, in certain conditions of 
licted with this dreadful disease, to present the alternative of 
irpation of the uterus, and with a similar course of argu- 
lat we would use for extirpation of a breast affected with the 
use! If, in the interest of suffering humanity, we may be 
!y allowed to take such a course we need not be quite so 
?hen we are obliged to give the dreaded diagnosis, carcinoma 

i may select our first cases with proper caution, I would sug- 
ve take the following conditions as favorable for the opera- 

ertain diagnosis of cancer. 

! age, past the climateric period or under 30. 

36 involving only the uterus. 

en amputation of the cervix win not remove all diseased 

en the general condition of the patient is favorable. 

IT successful cases presented a spread of the cancerous W» parametric Hague. 




J. M. Lee, M. D., Chairman, - Rochester. 

Dre. F. E. Doughty, New York City. 

Sidney F. Wilcox, New York City. 

H. I. Ostrom, New York City. 

M. O. Terry, ... ... Utica. 

S. N. Brayton, Buffalo. 

George Allen, Waterville. 

With the invited co-operation of 

Prof. H. F. Biggar, Cleveland, Ohio. 

Prof. J. G. Gilchrist, Iowa City, Iowa. 

*Obser vations on the Medical and surgical 

Treatment of Tumors and cancers 

of the Breast. 

By M. O. Terry, M. D. 

utica, n. y. 

I intend this paper to represent my experience in the treatment of 
these pathological conditions. The subject of this paper is one of 
great interest to every physician and surgeon. Every practitioner has 
cases — from the condition of induration of the breast to the progressed 
stage of some variety of cancer — upon which he sits in judgment as 
to the best method of disposing of them. It may be of interest to 
you to refer you to a few valuable works on the subject. I therefore 
note the following as worthy of perusal : 

*Semi- Annual Meeting-, '86. 


7i Bureau of Surgery. 

" Clinical Notes on Cancer.." Herbert S. Snow, Surgeon Cancer 
Hosp., Brompton, Eng. 

44 On Cancer of 'the Breast" Thos. W. Nunn, Middlesex Hosp., 

*' A New and Successful Mode of Treating Certain Forms of 
Cancer" by Alexander Marsden, Senior Surgeon to Cancer Hosp., 
London, Eng. 

" Sarcoma and Carcinoma*" Henry Trentham Butler, F. R. C. 
S., England. 

" On Cancer, its Allied and Other Tumors, with special reference 
to their Medical and Surgical Treatment" F. Albert Purcell, F. R. 
C. S., England. 

" A Treatise on the Breast and its Surgical Diseases" H. I. 
Ostroin, M. D. 

" Tumors of the Mammary Gland" Samuel W. Gross. 

In these works will be found the differential diagnosis, the theory of 
development, and the varying methods of treatment. Authors are 
pretty equally divided as to whether cancers are hereditary or caused 
by an injury of some sort. I am in sympathy witli those who believe 
that cancer begins from an injury or an induration following an inflam- 
mation, as an abscess for instance. In my clinical notes I may be able 
to show why I believe in this theory. 

An induration may remain stationary for years and finally pass into 
the tumor state and from that into some form of cancer ; or it may 
disappear either of itself by absorption or by the aid of remedies used 
internally and externally. I am unable to say just what disappeared 
in the three cases here presented. But it is my opinion that they were 
all indurations. 

Case 1. Miss Y., set. 35 years, had a hard formation in the left 
breast the size of half a hen's egg. It had been noticed for ten years 
but had remained stationary. As she was adverse to an operation I 
gave her the benefit of the doubt and prescribed internally : Conium, 
Phytolacca dec, Arsen. iod, Bellad., Dulcamara and Pulsatilla at 
various times in tincture form, and a cerate of either Phytolacca or 
Conium was used. In this case, as also in the two following, the 
induration was not attached to the underlying tissue, was movable, 
and the skin perfectly normal. This case cured in six months. 

Case 2. Miss C, aet. 31 years, nervo-sanguine temperament; had 
experienced pain in the left breast for one week, at which time she 

Bureau of Surgery. % 75 

noticed a "hard lump" the size of a walnut. She had received no 
injury so far as she knew and could not say how long the hardness had 
been in the breast. She was given the same treatment as Cash 1, with 
intervals of cessation, for one year. I called on purpose to examine 
the case to-day and could find no induration. Time of cure, one year. 

Case 3. Miss W., set 32 years, nervo-bilious temperament; had 
been married seven years. The induration, which was the size of a 
small walnut, had been caused by an injury. It had been noticed for 
only two and a half years. Under treatment it disappeared within 
three months. N 

We cannot say just when we have a simple induration or when we 
have the iirfct transition, the adenoma, as only the microscope can 
decide that question. At some time both conditions will exist at the 
same period. The patient being under forty years of age, having no 
pain, and there having been no change or increase in size, a short 
course of treatment might be tried. The u lump " in the breast should 
be as little manipulated as possible — at least no pain should be induced 
by doing so. In the early period of a chronic induration massage 
might be of use. All such treatment requires great discrimination and 

I shall now direct your attention to the results obtained by the 
operative procedure from the simple adenoma to the scirrhus. 

Case 1. Miss W., set. 40 years, nervo-sanguine temperament ; has 
had a hard growth between axilla and nipple of right side for a num- 
ber of years. It was removed and dressed with an antiseptic dry 
dressing. The woand was healed perfectly in ten days. Analysis by 
Dr C. Heitzman, microscopist New York City — adenoma. 

I gave the doctor the specimen without any information as to location. 
He said : " Should this nodule have appeared near the mammary 
gland, or even in the axillary pit, it is what is termed an accessory 
lacteal gland — pretty rare formations. It will not return." 

Case #. Miss J., aet. 35, nervo-bilious temperament. She had a 
tumor of the right breast removed three years previously by the 
Kingsley caustic method. The tumor was removed but the ugly scar 
the caustic left should dissuade anyone from using it. This had been 
called a cancer, but it was undoubtedly at that time a simple adenoma. 
With the above history I deemed an immediate operation advisable. 
The tumor was the size of a small hen's egg, and there was an occa- 
sional pain through it. It was constantly on the mind of the woman 
that she had " another cancer " and that it would be short work with 

76 Bureau of Surgery. 

her. As the tumor was not adherent, the skin perfectly healthy, and 
there was no axillary infiltration, I simply removed the part involved. 
Dr. Heitzman, who examined it, diagnosed it a fibroma and said it 
would not return. But it returned within six months. I then removed 
the entire gland, examined the axilla, and found it free from infiltra- 
tion or any induration. I informed my pathologist that he was " no 
good," but this time sent him the gland. He replied : " This is a 
' fibrosarcoma' of little malignancy — ' Clark's simple tumor.'" It 
took me quite a while to find out nests filled with small globular 
corpuscles, almost encysted by fibrous connective tissue, the latter 
making up the greatest portion of the tumor. Lastly I found the 
sarcomatous or myxomatous feature in it, quite marked, too. Sar- 
comatous tumors are of comparatively little malignancy in the female 
breast, and if thoroughly extirpated admit of a permanent cure." 

There has been no return of the growth and there are no indica- 
tions in the region of the cicatrix, or in the axilla, of any disease. « 
The wound following the operation healed under the dry dressing in 
ten days. A scaly formation appeared on the cicatrix six months after 
the wound was healed. An application of Arseuious acid mixed to 
the consistency of cream, with mucilage of acacia, cured this diffi- 
culty. This is the preparation that Marsden, of England, used in cer- 
tain forms of cancer. 

Case 3. Mrs. B., set. 56 years ; nervo-sanguine temperament. The 
breast had pained her for some months before she consulted her phy- 
sician. As soon as he was consulted I was called to examine the case. 
The right breast was very hard and was in one solid mass. The skin 
was extensively infiltrated. Dr. Gross, of Philadelphia, who saw the 
case, called the tumor u scirrhus" and stated that the lymphatic infil- 
tration was due to pressure. 

As he advised removal, it was extirpated. I was obliged to cut 
through the thickened skin, which extended beyond the periphery of 
the gland. The axillary glands, which were indurated, were carefully 
pulled out and freed with the scissors. It might be well to remark 
that the left breast was undergoing degeneration at the time of opera- 
tion. The skin was very much infiltrated and the breast hardening. 
The microscope showed the tumor to be a scirrhus or hard cancer. 

Dr. Heitzman said: u It is of comparatively small degree of 
malignancy. The fibrous connective tissue is largely in excess over 
the epithelial nests, which latter are small and composed mainly of 
single rows of epithelia. The prognosis, you know, is doubtful." 
The patient lived just one year. 

BurAau of Surgery. 77 

Case 4- Miss G., eet. 41 years ; nervo-sanguine temperament. 
About fifteen years since she received a poke of an elbow. When I 
operated it had began to ulcerate. It was removed, together with the 
axillary glands, which were greatly indurated. She died in eleven 
months from constitutional poisoning, or cancer-cell absorption. 

Case 5. Miss B., set. 37 years : nervo-sanguine temperament ; had 
a tumor in the breast for ten years; removed it. Diagnosis — 
fibroma. It is seven years since removal ; no return, but is married 
and has had one child. 

Case 6. Mrs. S., set. 68, nervo-lymphatic temperament ; weight, 
185 lbs. ; had an immense growth of the right breast. It was evi- 
dently a scirrhus. Axillary glands not involved. There was hardly 
enough flap to close the wound. Healed in twenty days. Is now 
feeling well in every way. Cannot say whether it will return or not. 

Each will form his own conclusion in regard to the disposition of 
these cases. In the stages between the induration and the malignant 
growth, the knife is the safest, the most painless, and a comparatively 
6ure means of relief. The removal of the breast, when suffering with 
malignant disease, gives great relief to the patient, and is much easier 
to dress and care for. Every difficulty of the breast should receive 
prompt attention. 


By George Allen, M. D. 


Case I. — Mrs. M. W. T., aged thirty-five years ; has been married 
several years ; no children ; dark complexion, eyes and hair ; is tall and 

In October, 1863, she consulted me with reference to a tumor located 
in the left breast. The tumor was of a stony hardness, smooth, 
not sensitive to pressure nor painful at any time. It was situated 
above and to the inside of the nipple. The nipple was not retracted 
nor eczematous. 

The patient stated that she had been aware of the presence of the 
tumor six months, and that during that time it had not changed in 
form or appearance. 


The tnmor at this time is about the size of a butternut. The 
patient being averse to an operation, internal remedies were adminis- 
tered six months, without any perceptible effect. The remedies 
employed were Iodide of Arsenic and Iodide of Lime. 

The patient's general health during all this time was excellent. At 
the end of this period, however, the tumor began to enlarge slightly, 
and an immediate operation was advised. On April 22, 1884, Dr. 
M. O. Terry removed the tumor and with it a considerable portion of 
the surrounding tissue. 

The tumor was sent to Professor Heitzman, of New York, who 
pronounced it a cancer, and stated that it would return, which it did. 

Four weeks after nodular growths made their appearance near the 
cicatrix of the first operation. These were removed in June, 1884. 
Other nodules appeared, and were removed in July. In September, 
still another crop of nodules appeared, and early in October the patient 
went to the Hahnemann Hospital, in New York, and was placed under 
the care of Dr. J. C. Minor, who removed all the cicatricial tissue, all 
the nodules that were present, in fact, all the tissue down to the fascia 
overlaying the pectoralis major, and even a portion of this muscle was 
removed. He then extended the incisions and cleared out all the axil- 
lary lymphatic glands. 

After this operation no more nodules appeared for five months, when 
one of small size was distinctly noticeable. 

The Phenic acid treatment was now resorted to, using both the 
hypodermic and internal methods of administration. For one month 
there was no growth of the nodule ; at that time, however, a new one 
appeared, and both were removed in March, 1885. Still others were 
excised in May and July of the same year, one being above the clavicle 
and overlaying the external jugular vein. 

During all this time the patient's health had remained excellent ; in 
fact better than usual. She recovered quickly from every operation, 
most of the wounds healing by first intention. The patient suffered 
no pain at any time. More than thirty cancerous nodules were 
removed in the course of fifteen months. 

After the operation in July, 1885, the disease changed in character. 
No new nodules appeared, but instead a general and rapidly growing 
induration began in every part of the mammary region of the affected 
side. Signs of pulmonary induration at the upper part of the right 
lung appeared ; a cough supervened, and the patient died in a few 
weeks, suffering no pain, and escaping entirely the horrible features 



which usually attend the closing stages of cancer when left to pursue 
its course without operative treatment. 

It is doubtful if anything could have saved this patient ; it is certain, 
however, that much valuable time was lost at the outset by useless 
waiting and the administration of remedies. 

As it was, the patient's life was undoubtedly prolonged by the oper- 
ations ; she suffered less and died easier than if the disease had pur- 
sued its course without interference. 

I believe this result obtains in nearly all cases. When operative 
treatment fails to save life, it enables the patient to go through the 
ordeal of this terrible malady with less suffering, and is better pre- 
pared to escape the loathsome termination as often seen. 

Case IT. — Lady ; aged forty years ; single. A tumor was removed 
from the right breast eight years previously. This patient came to me 
in September, 1884, having two nodules in the cicatrix of the former 

The patient, who is a spiritualist, had had the first tumor removed 
by a woman of the same faith, who claimed to act under the direction 
cf Sir Astley Cooper. Sir Astley' 8 diagnosis was " scirrhous cancer," 
and according to his directions, the wound from the operation was 
allowed to heal under a poultice of slippery elm. 

The woman remained well eight years, when the nodules appeared 
as before stated, a result, it was supposed, of extraordinary use of the 
arms while acting as a masseur. x 

These nodules I removed in September, 1884. They presented all 
the characteristics of concerous nodules. There has been no return of 
the trouble since, now about two years. 

In this case, humoring the patient's whim, I allowed her to poultice 
the wound as she had done on the advice of Sir Astley Cooper's ghost, 
after the former operation. 

Case III. — A married lady, aged forty-eight years, having a tumor 
in the left breast which presented some of the characteristics of can- 
cer. I advised immediate removal, although the diagnosis was doubtful. 

On removal, a microscopist pronounced the growth a lipoma. The 
patient remains well, now more than a year, and is happy in the assur- 
ance that she has not a cancer — an assurance impossible to have 
obtained without the operation. 







By K. C. Moffat, M. D. 


During convalesence from an injured elbow the patient was required 
to carry a heavy weight. The strain of carrying was felt beneath the 
left breast, and on one occasion a severe pain, as of something breaking 
away, caused her to cease lifting or carrying. 

A month later the breast came under my care, when I detected " a 
glandular tumor" below the nipple, which soon became painless, and 
fef<i ' treatment was discontinued. 

]±:.y Two years later, (February, 1881,) the breast was again placed under 

bi:- my care. There was now a roundish induration in the substance of 

[£• the mamma, below and extending beneath the nipple. The breast felt 

heavy and sore all the time, and there were sharp-shooting and stinging 
pains, frequently recurring. 

The patient was a maiden lady, aet. 35, of nervous, but not hysterical 
temperament. Her general health was only disturbed by not infre- 
quent obstructive (?) dysmenorrhea. 

For three months I prescribed Con., Ign., Ars., Lach., without suc- 
cess, TEtnd in April I submitted the breast and its history to Dr. W. M . 
L. Fiske for diagnosis and suggestions. 

The tumor was now lobulated three inches long, extending from one 
inch within the nipple outwards, where it turned up toward the axilla. 
It did not extend beyond the limits of the breast. The nipple was 
somewhat in-drawn, but neither movable on the tumor nor absorbed in 
it. Both nipple and breast were painful on handling, and were still 
subject to pains as above stated. The axillary glands were not affected 
and the dysmenorrheoea was neither greater nor less than customary. 
The breast was larger than its fellow, and mis-shapen ; also constantly 
painful by reason of its weight. Felt through the cellular tissue, the 
induration seemed harder than gristle, and its lobulations were easily 

Dr. Fiske pronounced it cancerous, and fearing its further degen- 
eration, counseled extirpation with the knife at once. To this the 
patient objected to decidedly, that he proposed temporizing by the 
trial of continuous pressure, till she should herself see that excision 
was the wiser course. Accordingly broad bands of sheet rubber were 


Bureau of Surgery. 81 

Btretched across the breast, secured by gum diachylon to the skin 
beyond. These were renewed once or twice a week, the skin being 
kept in good condition by thorough ablution. Improvement in the 
size of the breast was manifest in six weeks, though the patient 
announced it by her feelings earlier. This treatment was kept up for 
six months — progress during the latter months was slower than in the 
earlier, because the reduced tumor was less compressed by the rubber 
band through the overlying substance of the bosom. At the end of 
six months compression was discontinued ; an ointment of Citrate of 
Iron applied for three or four months more. 

Ars. iodat. 3d. became the principle internal remedy, Iod. having 
been found insufficient, but the above named were used according 
their indications at the moment. 

Five years later. — At present the general health of the patient is 
good, dysmenorrhoea as formerly, being her bete noir. The afflicted 
breast is' now smaller and less pendulous than its fellow, and a small 
induration can be found by careful feeling beneath the nipple, but 
there is no pain, and nothing else to indicate what it was, or has been. 

•The Treatment of the Pedicle, in hys- 

By II. I. Ostrom, M. D. 

Surgeon to Ward's Island Hospital. 

With our present facilities for opening the abdominal cavity, and of 
manipulating the abdominal organs, little more than the surgical risk 
that attends any serious operation can be said to belong to this part of 
hysterotomy. Nor are we to consider the removal of the uterus and 
uterine tumor as the pivot around which turns our success or our fail- 
ure. In hysterotomy, as in ovariotomy, the treatment of the part that 
remains in the abdomen, not the part that is taken away, always has 
been and always will be, the most important step in the operation, the 
one, more than any other, that has to do with our mortality tables. 

•Read by title, Semi- Annual Meeting, 1886. 


82 Bubbau of Surgery. 

I do not wish to underrate the value of the great care and attention 
that have been bestowed upon the minor steps of hysterotomy ; hys- 
terotomy would probably not be possible without them ; but at the 
same time, I believe that some could be omitted — though we are rather 
loth to take the initiative, not knowing how much each detail may con- 
tribute to success — without danger, if the principal peritoneal wound, 
the uterine pedicle, is properly dealt with. Accordingly, therefore, 
the chief consideration in hysterotomy, is the management of the 

The importance of this question is fully appreciated, and it is the 
one that in connection with abdominal surgery is to-day discussed more 
than any other : it is in truth the moot-point in the operation for the 
removal of the uterus. We have therefore to inquire why this should 
be so ; why this step in hysterotomy should outweigh in importance all 
the other steps of the operation. The inquiry is necessary, for without 
it we cannot treat the uterine pedicle in accordance with the well- 
grounded principles of the healing of wounds, the application of 
which will insure success in operative surgery. I cannot avoid the 
conclusion that the hitherto high rate of mortality in hysterotomy may 
in no small measure be traced to our failure to treat the lesions inci- 
dent to this operation upon the same principle that we apply to other 
lesions ; for from a surgical standpoint, I fail to find any reason for 
considering the abdominal cavity as differing vitally from any other 
region of the body. In all essentials, the processes of repair are the 
same, whether we deal with the osseous or the nervous structure, with 
connective or epithelial tissue ; and correspondingly, the same princi- 
ples of treatment apply whenever wounds are to be healed. 

The part that forms the pedicle, after removing the uterus, is com- 
posed of more or less of the cervix, or possibly only of the vagina, as 
in a case that I recently operated upon, where the entire uterine body 
was occupied by the fibroid tumor, and I was obliged to throw 
my ligature around the vagina before I could remove all of the 

If the cervix is divided, and the cavity of the uterus opened, there 
remains a rather fleshy stump, through the center of which is estab- 
lished a communication between the abdomen and the vagina. This 
stump is rather vascular, though the danger of vascularity depends 
upon the size and character of the tumor that occupies the uterus. The 
surface of the stump being uncovered with peritoneum, if allowed to 
follow a natural course, will granulate, and suppurate, before it can 
heal. There are, therefore, three indications to be met in the treat- 


N BtTKBAtT Off SufcGEBY. 83 

ment of the uterine pedicle, which for convenience we will discuss in 
the order in which they have been mentioned. 

The vaginal canal is the anatomical sewer for the pelvis, and upon 
first thought it seems as if we should utilize this fact, and by some 
contrivance convert the cervical canal into a drainage tube when one is 
called for. But a moment's reflection will lead to a different conclu- 
sion ; for, though the vagina occupies a most favorable anatomical and 
mechanical position for draining the pelvis, this very fact is opposed to 
utilizing it for that purpose ; because, being situated at the bottom of 
the pelvis, fluids naturally gravitate there, and any artificial opening 
that may be made, either in the vault of the vagina, or by amputating 
the uterus, through which a drainage tube is passed, will expose the 
patient to the danger of absorbing into the general system the effete 
fluid that constantly lies in contact with the cut surfaces. A drainage 
tube occupying the cervical canal is open to the additional objection, 
that around it there would be difficulty in securing the stump properly, 
and hence in bringing about rapid healing. 

So far we have spoken of the baneful influences that proceed from 
the abdominal cavity; it is very probable that still more harmful 
ones — septic germs — are conveyed from the vagina into the abdomen, 
when that cavity and canal are made to communicate, even though the 
vaginia and uterine cavity have been rendered aseptic before the oper- 
ation, and are afterwards kept as far as possible in that condition. I 
am aware that some very successful surgeons still occasionally drain 
through the vagina, but I cannot avoid the belief that by so doing they 
increase the risk of an already grave operation. 

We now approach the question, how shall we close the central open- 
ing in the pedicle, and so avoid one danger in hysterotomy ? 

If this is accomplished by constriction with a ligature that encircles 
the entire pedicle — proposed by Kleeberg — the risk is encountered of 
cutting off the nourishment from the distal end of the stump to such 
a degree as to cause sloughing of that part. I do not say that this 
necessarily follows leaving the ligature in situ, but that it may follow, 
unless the cut surfaces of the pedicle establish vascular relations with 
other abdominal organs and structures, cannot be doubted. 

Principally to guard against this accident, and to control hemorrhage, 
the extra-peritoneal, or clamp method of treating the pedicle, was 
adopted, and is still adhered to by some successful operators. 

Viewed as a surgical manipulation, it is simpler, and more expe- 
ditious, to apply the clamp, and sew up the abdominal wound — such 
cases do not often require drainage, which may be regarded as a favor- 

• : ■» *■ 

84 Bureau of Surgery. 

able circumstance. But are the principles upon which the exfra-peri- 
toneal — I would rather say the extra-abdominal — treatment of the 
pedicle is based, as truly scientific and simple, as are those that form 
the ground for the intra-peritoneal — intra-abdominal method. 

Let us pause for a moment to examine this question of principle, 
the most important thing in science, and in life — a thing, the right 
understanding of which must always decide for or against any matter 
that calls for discussion. 

We have here to choose between an external healing and an internal 
healing ; between drawing a structure that naturally belongs in the 
abdomen, out of that cavity, and retaining it upon the surface ; and 
treating this structure as we treat . any other wounded structure — in 
situ. With the external method, the pedicle is brought out of the 
abdomen to control hemorrhage ; to avoid the absorption of pus, and 
to prevent the possibility of adhesions forming between it and other 
organs. In the internal method, the pedicle is dropped in the 
abdominal cavity ; hemorrhage is controlled as we control it elsewhere, 
by ligating the bleeding vessels, or by cauterizing them ; the presence 
of a large suppurating surface is avoided, by bringing the edges of 
the wound together, and so retaining them — as we do in other opera- 
tions; the danger of contracting adhesions is guarded against, by 
covering with peritoneum the surfaces that could give rise to such 
adhesions. If we carry, this brief comparison to the length of time 
consumed in the healing of the abdominal wound, the facts are greatly 
in favor of the intra-abdominal method, for when the pedicle is so 
treated the entire wound usually heals by first intention, and proceeds 
without interruption ; but when the clamp is applied, the presence of 
the sloughing and suppurating pedicle greatly retards the process of 

I am well aware that the bulk of statistics is at present opposed to 
the intra-abdominal disposition of the pedicle in hysterotomy ; but the 
same was true a few years ago in ovariotomy, while to-day the most 
successful ovariotomists have discarded the clamp, and drop the pedicle 
into the abdomen. A few laparotomists, notably A. Martin, have 
even now wholly abandoned the clanip in hysterotomy, and these men 
deserve great praise for their boldness in trampling on tradition, and 
applying in the face of experience, what they believe to be the true 
principle of treating the pedicle. Their courage, and I am glad to 
record their success also, should form an incentive for other operators, 
not only to follow in their footsteps, but to go beyond their resting- 
place, nor cease until, as a compensation for the mutilation that must 


Bureau of Surgery. 85 

be inflicted, we can exclude from abdominal surgery the tjiree factors 
of non-success, inflammation, suppuration and septicaemia. 

Tested by the underlying principles of operative surgery, and what 
is known of the processes of repair, there can be little doubt that the 
intra-abdominal is the most scientific and rational method of dealing 
with the pedicle, and if it is not followed by success, we may be sure 
that our application is at fault. With this more perfect, I hope to see 
the day when hysterotomy will give as high a percentage of recoveries 
as we can now record for ovariotomy. 

Abstractly, there seems to be no reason why the removal of the 
uterus — it not being an organ essential to animal life — should be 
attended with a higher mortality than the removal of an ovarian 
tumor. I will even go farther, and say that, excluding the proximity* 
to vital organs, and vital functions, there is no reason why either the 
uterus or the ovaries should not be removed with as little risk to life 
as an amputation is now performed. Why should we continue to look 
upon the peritoneum with the old-time dread ? and why fear that it 
will play us false, notwithstanding that we treat it with consideration 
and gentleness? The truth is, no structure of the body is function- 
ally more favorable to operate upon than the peritoneum ; no 
internal structure when wounded heals more readily and with less 
constitutional disturbance than this serous abdominal sac. So power- 
fully have I been impressed with this fact, from my abdominal opera- 
tions, that I have come to regard the peritoneum as the protective 
covering of the abdomen, and to insure it the continuance of this 
office, I endeavor, as one of the most important steps in this opera- 
tion, to leave this membrane, however much I may have been obliged 
to mutilate it, intact, before closing the abdominal wound. That the 
peritoneum, in operations that involve its structure, is prone to become 
inflamed, and rapidly to pass through the different stages of inflamma- 
tion, to a fatal termination, we can unfortunately illustrate too 
often. Why is this? Chiefly, I apprehend, because we are not suffi- 
ciently particular to repair the structure; because we do not with enough 
care preserve its continuity, but leave some places uncovered that, follow- 
ing the course of repair, become the source of contamination and infec- 
tion. It was a step in this direction when Sir Spencer Wells proposed to 
include the peritoneum in the abdominal sutures, and the effect was at 
once perceived upon the statistics of laparotomy ; and it was a still more 
important step towards success in hysterotomy, when Schrceder pro- 
posed to cover the uterine pedicle with peritoneum, and so assist in 
restoring the function of the lining of the abdomen. 

• ► 

-'• V 


; Though possibly irrelevant to the subject of how to treat the uterine 
pedicle, I desire to anticipate any charge of inconsistency that may be 
made, for the prominence that I have given to the necessity of pre- 
serving the continuity of the peritoneum covering the stump, and the 
silence so far maintained regarding the treatment of peritoneal adhe- 
sions. But it must be remembered that when these adhesions are 
broken up, the entire thickness of the peritoneum is rarely involved, 
so there is still left peritoneal surface, the bleeding from which, as has 
been shown by Mr. Tait, is usually controlled by sponge pressure. If 
the adhesions are firmer, and necessitate deeper dissection, the condi- 
tion becomes one of the most serious complications of laparotomy, and 
is best met by the actual cautery, which leaves the nearest approach to 
an inactive surface of any means at our command. 

As a summary of what we have said of the two methods of treating 
the uterine pedicle, extra and intraabdominal, I would enter a plea for 
the application to this step in hysterotomy, of the recognized princi- 
ples of operative surgery ; and for discarding those cumbersome appli- 
ances, (as any purely retentive apparatus must be when compared with 
curative treatment) that can seldom find a place in the surgery of the 
nineteenth century. 

So far as we have been chiefly concerned with the principles that 
underlie the treatment of the uterine pedicle, and from these princi- 
ples, as we understand them, have drawn the conclusion that the intra- 
abdominal method answers the requirements of scientific surgery, and 
is in accordance with the most advanced surgical manipulations ; and 
have in consequence of this conclusion expressed the belief, in opposi- 
tion to statistics, that this method, when perfected, will give better 
results in hysterotomy than the extra-abdominal treatment of the 
pedicle. The details of the intra-abdominal method may now justly 
engage oijr brief attention. 

And here let me disclaim any originality of procedure, save possibly 
in one minor particular — the method of incising the stump. But 
even in this I may not rightly be credited with priority ; all I can say 
is, that I have not found the suggestion from any other operator. 

After throwing an elastic ligature around the base of the tumor, or 
uterus, as the case may be, A. Martin, by an eliptical incision, ampu- 
tates the tumor; This leaves an excavated stump, at the bottom of 
which the cervical canal enters. Now, in consideration of the after- 
treatment of this stump, I prefer, when it is possible to obtain the 
tissue, to transfix the stump with a straight-bladed bistoury, from before 
backwards, and by cutting out and up, form the first lateral flap. The 

Bureau of Surgery. 87 


second flap is made by entering the knife at the initial point, and cut- 
ting in the same manner, but from the opposite side of the stump ; by 
this last incision thp tumor is amputated. We have thus two straight 
flaps, made at the expense of a wedge-shaped piece of tissue removed 
from the stump, above the ligature. These when brought together 
make a good conicle pedicle, the surfaces of which can be more per- 
fectly coaptated than when the eliptical incision is made. 

The cervical canal is then brought together with interrupted cat-gut 
sutures, and the elastic ligature loosened sufficiently to detect and 
secure the bleeding vessels. 

Since my last hysterotomy, in which there was considerable oozing 
from the stump from vessels that could not be ligated, I have ques- 
tioned whether in all cases it would not be well to pass the cautery iron 
over the exposed surfaces. Wounds generally, treated in this way heal 
very rapidly, probably because the cautery when not carried to the 
extent of charring the tissues, stops this oozing, which always interferes 
with healing by first intention. 

The hemorrhage and oozing controlled the fleshy surfaces remained 
to be disposed of. I think to Schrceder belongs the credit of suggest- 
ing that this part of the pedicle should be held together with a contin- 
uous suture, and that the peritoneum should be made to cover the 
entire stump. This method of treatment is based upon the soundest 
principles of operative surgery. We know that an aseptic wound, 
whether rendered so by elaborate antiseptic machinery, or by strict 
cleanliness, in which hemorrhage has been controlled, and from which 
oozing has ceased, will heal without suppuration, if accurately brought 
together and sealed. Now this is exactly what suturing the pedicle in 
successive layers seeks to accomplish, and that such a result is thereby 
accomplished, we find sufficient proof in the statistics of A. Martin 
and Schrceder, both of whom have adopted this method of treating 
the pedicle in their hysterotomies. 

The method of introducing the sutures has much to do with ulti- 
mate success. The best results will be obtained by holding the entire 
surface of the wound in contact, and not the edges only. This may * 
be accomplished by allowing the needle to traverse the length of the 
wound, a few lines outside of its surface, very much as we introduce 
the deep sutures when operating for the repair of a ruptured peri- 

Finally, the peritoneum is brought forward — in Schrceder's method 
there remains a frill of peritoneum around the stump, after amputating 
the tumor — and with fine sutures secured over the stump. It will 

.V \ 





* 1 






88 Bureau of Subgery. 

thus be seen that the wound is perfectly closed, and should give no 
further trouble in the progress of the case. As the cut surfaces are 
held in contact, and the hemorrhage, by this means, and by separate 
ligatures has been controlled, the elastic ligature may with safety be 
removed, and the stump dropped into the abdominal cavity. 

From the importance attached to preserving the continuity of the 
peritoneum, it may with justice be concluded, that the suturing of the 
peritoneum is one of the principal steps in the treatment of the 
pedicle. Other intra-abdominal methods of dealing with the uterine 
pedicle have been proposed, as allowing the elastic ligature to remain 
without suturing the serous membrane, or dropping the thoroughly 
cauterized stump into the abdomen ; but, judged by the principles of 
operative surgery, they do not seem to be perfect methods, nor have 
their adoption been followed by the same good results — save, possibly, 
in the hands of Mr. Keath, who, after cauterizing the stump, returns 
it to the abdomen— that have attended treating the pedicle by succes- 
sive suturing. 

I have referred to my preference for the terms, intra-abdominal 
and extra-abdominal^ as substitutes for the ones that are in general 
use, to describe the two methods of treating the uterine pedicle. It is 
a small matter, and turns upon the strict use of words. For example, 
it is very evident when the pedicle is treated by successive suturing, 
that the final set of sutures, those that secure the peritoneum, exclude 
the pedicle from the peritoneal cavity, and the method by this manipu- 
lation, is at once converted to an extra-peritoneal treatment of the 
pedicle. But here arises a confusion of terms ; for extra-peritoneal is 
usually employed to designate the use of the clamps or ligature to 
secure the pedicle outside of the abdomen. It seems therefore, if we 
would speak with accuracy, that we must use three terms to describe 
the methods in vogue, of dealing with the pedicle. Extra-abdominal, 
or the use of the clamp ; intra-abdominal, or any method that does not 
include covering the pedicle with peritoneum; and extra-peritoneal, 
or any method that secures the peritoneum over the pedicle, and 
endeavors to preserve the continuity of the peritoneum. 

* Supra-Pubic Cystotomy. (Clinical.) 

By J. M. Lee, M. I)., 


D. L. S., aged 67 years, came under my care during the current 
year, through the kindness of Dre. Hurd and Dayfoot. He had been 
ill for five years. While returning from a business trip he noticed 
that he was not able to urinate in the usual way, but by getting over 
on his hands and knees he could pass water as freely as ever. Finally 
he waB unable to relieve himself even in this way, and the water had 
to be drawn. Later large hemorrhoidal tumors developed about the 
anus, which were operated upon ; this afforded temporary relief. 
However, two years ago they returned and added materially to his suf- 
ferings. It was unusual for him to hold his water more than an hour 
at a time, and even then the last half was spent in acute suffering from 
tenesmus both of bladder and rectum. The piles would protrude and 
the only relief was found in drawing the water; the last few drops 
were often bloody. This condition continued, with neuralgia about the 
hips, in the testicles and down the thighs — of a shooting lancinating 
character. Occasionally sharp darting pains passed from the bladder 
along the perineum, and centered in the glans penis, which were 
sufficient to compel him to start and groan. There was smarting, 
burning pain in the bladder ; burning sensation in the soles of the 
feet, which was very annoying and caused him to lie with them uncov- 
ered. He remained in this condition until last January, when he con- 
sulted Rochester's oldest 6urgeon, a " regular. " While catheterizing 
him the instrument came in contact with a calculus. He made five 
attempts, without an anaesthetic, to crush the stone, and succeeded in 
removing the greater part of it. During the last operation a frag- 
ment, about the size of an almond, was caught in the jaws of the 
lithotrite and drawn through the urethral canal to within two inches 
of the meatus urinarius, where it became arrested. Of course the 
urethra was lacerated. While he was preparing to cut the fragment 
out it crumbled and disappeared. Within a few days he made another 

•Semi- Annual Meeting, 1886. 

90 Bureau of Surgery. 

examination under ether, and decided that the stone had all been 
removed* Notwithstanding, after the usual time for convalescence 
had elapsed, the distressing symptoms remained and were intensified, 
probably from the excessive instrumentation. The patient, on inquir- 
ing as to the cause of his continued sufferings, was informed that they 
proceeded from a thickened state of the bladder, and that increasing 
quantities of water should be injected twice daily to overcome it. 
This, however, failed to afford the desired relief. He was confined to 
his room the most of the time, being able to walk for a short distance 
only. Many weary hours were spent in sitting over the edge of a 
slop-jar, which assisted him to bear the tenesmus of both bladder and 
rectum, the latter of which was very severe, as the piles were fre- 
quently strangulated. This position enabled him to go from one-half 
of an hour to two hours without resorting to tl)6 use of the catheter. 
When I was called, March 27th, I made a careful examination with 
the following result. Prostate gland enormously enlarged ; double 
inguinal hernia; large prolapsed hemorrhoids; albuminuria; resistant 
stricture three inches from the meatus ; palpitation and abnormal 
heart sounds. On attempting to sound for stone, the searcher caught 
in a false passage, made by the patient in trying to catheterize him- 
self, so the effort was discontinued. Knowing that some of the symp- 
toms might be due to the stricture, and that its presence prevented a 
thorough examination, I decided to divide it. One week later, assisted 
by Dr Dayfoot, I incised the meatus and stricture behind it to No. 
40 f, after which a full sized conical sound passed easily. The wounds 
were kept open, and at the end of two weeks were considered healed. 
I then introduced the searcher, and detected fragments ef stone. On 
April 28th, assisted by Drs. Dayfoot and Bissel, I crushed and 
evacuated a portion of the pieces, by Dr. Bigelow's method. I now 
became convinced that this operation was impracticable for their com- 
plete removal. The patient was allowed to recruit for a few weeks, 
and on June 10th, assisted by the same gentlemen, I performed epi- 
cystotomy as practiced by Dr. Helmuth, with a few variations. The 
bladder, which was quite ammoniacal, was washed out night and 
morning for two days previous to the operation, with a saturated solu- 
tion of borax. The night before the operation a dose of castor oil 
was administered, and a thorough injection given the following morn- 
ing. Just before giving the chloroform, which was preferred on 
account of albuminuria, the bladder was washed out until clean, with a 
solution of Calendula 1 to 100. The patient was then anasthetized 
and placed on the table; the sonde-a-dard introduced and seven 

Bureau of Surgeby. 91 

ounces of calendulated water at a temperature of 100 deg. injected 
through it, which, though a very small amount, was all that we con- 
sidered safe to use. An assistant placed the colpeurynter in the 
rectum and injected fifteen ounces of warm water into it, which caused 
exceedingly severe spasms of the abdominal muscles, etc., notwith- 
standing the patient was profoundly chloroformed — even, to stertor. 
It was apparent that the operation could not thus proceed, and 
about three ounces of water were allowed to flow out of the rub- 
ber bag in the rectum. An incision two and one-half inches long was 
made in the linea alba, terminating at the root of the penis. When it 
was seen that the fold of peritoneum had not been elevated above the 
site of operation, and must be cut, the wound was enlarged towards 
the umbilicus to give room in which to work. The dissection was 
carried on carefully and the peritoneum divided. The spasms of the 
abdominal muscles, referred to above and the unusual straining, forced 
theintestines out, and Dr. Dayfoot, though at home in such places, had 
his hands more than full. The index finger of the right hand served 
to elevate the peritoneum and bladder, which tissues were previously 
secured by a loop of catgut, while the left hand guarded the opening 
in the abdominal cavity. The blood being sponged away, the grooved 
stilette was passed through the bladder, which was opened with a pair 
of angular scissors placed in the groove. Three sharp fragments of 
stone varying in size from an almond to a pea were removed by the 
finger, from a deep pouch behind the projecting prostate, and the 
bladder and wound cleaned. The incision through the bladder was 
sewed with fine catgut, using Glover's suture. The protruding intes- 
tines were replaced, and the incised peritoneum also closed with fine 
catgut and continued stitch. The integument was brought together * 
with No. 28 silver wire, to within one-half inch of the lower angle of 
the wound, where a tent was placed nearly down to the bladder wall. 
Calendula dressings were applied with plenty of absorbent cotton, and 
finally a pad of marine lint secured by a flannel binder. Catheter 
retained. "Within three hours reaction was established. Aconite was 
prescribed and the patient showed no bad symptoms until the com- 
mencement of the second day, when there was enormous gaseous for- 
mation, greatly distending the stomach and bowels ; nausea and fre- 
quent vomiting of a blackish watery substance. Although the utmost 
care was taken in selecting remedies this troublesome and dangerous 
condition continued until the sixth day. It was not possible to admin- 
ister any food by the stomach, and rectal alimentation was resorted to. 



92 Bubeau of Surgery. 

For some time previous to tbe operation his stomach had been in a 
catarrhal state, which I was unable to correct, and the irritation of the 
chloroform upon the gastric glands afforded the most dangerous and 
annoying symptoms during the progress of the case. 

The urine flowed through the wound the greater part of the time 
until the eighteenth day, when the catheter was removed and the 
water drawn every two or three hours. The temperature was not 
above 100 deg. during the progress of the case, and but for the weak 
stomach not a bad symptom would have developed. At the end 
of the fourth week he was about the room, and the sixth week left 
Rochester, his old home, to visit his son in Richmond, Ya., having 
good digestion and being quite free from urinary symptoms. 

Case #. July 16th, J. C, aged 67 years, was placed in my hands for 
operation by Dr. E. J. Bissell, who, with Dr. J. W. Buell, assisted me. 
The patient was very much enfeebled from years of suffering with 
chronic rheumatism, which had secondarily affected the heart. 

Operation same as above, but easier. Usual amount of . water 
injected into the bladder and rectum without the slightest difficulty. 
Incision two inches long; peritoneum not seen; stone encysted and 
turned out with the finger. Bladder wound not sewed ; integument 
closed with wire as usual, and tent retained in the lower angle of the 
wound./ Catheter not retained — allowing the water to flow freely 
through the wound until the end of the fifth day, when it ceased for 
a time — then the catheter was fastened in the bladder. Bronchitis 
set in on the eighth day, and a little later a colliquative diarrhoea. 
These diseases well-nigh exhausted his remaining strength and the 
healing process was apparently arrested for several weeks. Finally 
he began to gain, and no urine passed through the wound after the 
thirty-ninth day. He is now about his business, and considers himself 
well. The highest temperature was lOOf and this was present one 
evening only, after which it gradually assumed the normal point. 

None of the popular antiseptic " daubs or squirts " were employed 
in either case, but Aconite, Nux vom., Ars., Hepar sulph., Rhus tox. 
and Carbo. veg. were given according to their specific indications. 

It will be noticed that I did not sew the bladder in the last case ; 
however, I think the tardy healing was in no way due to this, as the 
state of the patient was incompatible with the repair of wounds. 


Treatment of Fibroid tumors by Elec- 
trolysis. DR. APOSTOLl'S METHOD. 

By Wm. H. King, M. D., 


Mb. Pbesident, Ladies and Gentlemen : My object in presenting 
this subject to you is : First, to give a full account of the various steps 
of the operation, so that any physician possessing a good knowledge of 
gynaecology and but a limited knowledge of electrophysics, can safely 
and effectually treat a case ; second, to give the result of observations 
both in my practice and at Dr. ApostolPs Clinic, of Paris, which I 
attended during a part of last July and August. 

The apparatus needed should have a careful consideration. 

A galvanic battery capable of generating 250 milli-amperes, with a 
selector that will introduce any number of cells without interrupting 
the circuit, must be chosen. Of course, some form of a cabinet bat- 
tery is to be preferred, as there is no acid to corrode the connections, 
and it is always in order ; but an ordinary zinc-carbon battery may 
answer the purpose, if it is kept in good condition. 

The external electrode should be large enough to cover all the avail- 
able space of the abdomen, thus reducing the resistance to a minimum. 

You will hear many say that any large electrode will answer. I wish 
to disabuse your minds on this point. The large mesh electrode, cov- 
ered with absorbent cotton, which is so highly recommended and so 
much used in this city, I consider useless for this purpose, for I have 
been unable, when using it, to pass a current of 250 or even 200 milli- 
amperes without causing excruciating pain, and, in most cases, blister- 
ing the abdomen. The one used by Dr. Apostoli is made of potter's 
clay. It is not elegant, but is very effectual ; and, if properly made, 
can be used without soiling the patient's linen or abdomen. The best 
material to be obtained here for making it is the finely ground clay 
used by artists for modeling, which can be obtained at stores dealing 
in art materials. A piece of ordinary muslin may be used ; but I pre- 
fer a towel which has been worn until it has become smooth and soft. 
This should be so cut that, when folded upon itself, it will be of the 
required shape and 6ize. The edge* are sowed together, leaving a 


space large enough for the hand to enter. The clay, well moistened, 
is packed carefully in the sack from one to one and one-half inches in 
thickness. A brass plate, soldered to one end of a copper wire, with a 
connector on the other end, should now be imbedded in the clay and 
the opening in the sack closed around the wire. This electrode must 
be kept moist, which can be easily done by keeping it in a little water 
in an ordinary dripping pan. It will then always be ready for use, and 
is certainly the most effectual one I have ever seen. Two hundred and 
fifty milli-amperes can be passed through it without causing pain or 
any perceptible redness of the skin. 

The internal electrode used by Dr. Apostoli is a small bar, twelve 
inches long and the size of a number eight French sound. One end 
j8 made of platinum and iridium, and shaped like an ordinary uterine 
sound. The other end is made of steel and has a trocar point ; this is 
used for making punctures. 

A milli-ampere meter is absolutely necessary to success. It is not 
my purpose to dwell on its construction. It is simply an instrument 
by which the intensity of the current can be told at any time, thus 
making the electric current mathematically u doseable." 

The Operation — There should be a distinction made here between 
the hemorrhagic and non-hemorrhagic, for one requires just the oppo- 
site kind of treatment to the other. With the former, the positive 
pole of the battery should be attached to the internal electrode, with 
the latter the negative. Please bear in mind these distinctions, for a 
treatment might prove most disastrous if you introduced the negative 
electrode into a uterus containing a hemorrhagic fibroid. 

The patient is placed on her back,, the thighs flexed in position for a 
bivalve speculum. The abdominal electrode is first placed in position, 
so that the skin of the abdomen mav become moist, before the current 
is allowed to pass. . The platinum end of the internal electrode is then 
inserted into the. cavity of the uterus and a celluloid or hard rubber 
shield passed over it until it reaches the os; this is done to protect the 
vagina and external parts. After this, a handle, which also serves as 
a connector, is passed over the steel end of the sound until it reaches 
the insulating shield and is made firm by a set screw. The current is 
then turned on. At the first treatment not more than twenty to thirty 
milli-amperes should be allowed to pass until the patient becomes 
accustomed to it, when fifty to one hundred may be used. 

At each treatment you will be able to increase the current ; but this 
increase will differ with different patients. With some not more than 
150 to 200 can be used ; but with the majority, if carefully handled, 
you will be able to pass 250 to 300 milli-amperes through the tumors. 



. »*- 



i V, 

Bureau of Surgery. 95 

This must be done without causing any severe pain to the patient, 
for if the operation is too painful, you will not be successful. 

These very powerful currents are the secret of success in this form s ^ 
of treatment of fibroid tuhiors, and, unless you can pass 150 milli- "'^| 
amperes through the tumor, you will not be successful. Dr. Apostoli v ^ 
attributes nearly all his failures to an inability on part of the patient to ;$| 
bear a strong current. This may be due to pelvic inflammation, but >:| 
more frequently to a hysterical tendency. » i$ 

The directions given above are those to be followed when there is <;J| 
no obstruction to the passage of a sound into the uterine canal. When 
such obstruction exists, a puncture should be inade, if possible, through 
the cervix, but never more than one and a half to two inches, with the 
trocar end of the electrode and the negative pole always attached. 
This generally requires an anaesthetic, although it is not unbearable 
without it. The external electrode is placed the same as before, to 
which is attached the positive pole, and a current of about 150 milli- 
amperds allowed to pass for ten minutes. This opening will remain 
for some time, and is used for the introduction of the sound in after 

Another method of treatment which has been employed by Dr. 
Apostoli is to puncture the tumor in its most prominent part, if possi- 
ble, through the vagina, if not through the abdominal wall,* with a 
needle insulated to within an inch of the end and connected with the 
negative pole of the battery. 

Many seem to be particularly afraid of puncturing the peritoneum ; 
but I believe it can be done in most cases, with proper precautions, 
with impunity, for I have punctured it a number of times with a large 
electric needle, and only saw the least b?d effect once, when the insola- 
tion of the needle was at fault. The time of which I speak a strong 
current was used, and from the exposed surface of the needle, the per- 
itoneum must have been considerably disturbed. The only result of 
this was soreness over a circumscribed area of four inches for a few 
days, no fever accompanying it. 

The precaution I would urge upon you, aside from thorough anti- 
sepsis, is to have the needle thoroughly insulated with hard rubber and 
not trust the patent varnish insulators of different manufacturers. 
There is another precaution which should be mentioned. In punctur- 
ing a fibroid tumor with insulated needles, the current should not be 
long enough or of sufficient intensity to induce suppuration. 

With all these operations, the law of antisepsis should be thoroughly 
observed. The vagina should be washed with an antiseptic solution 

'>: * . 


• z ""• 


before and after each treatment, and when a puncture is made, the 
patient should have a pledget of antiseptic gauze continually in the 

Exactly the way this treatment reduces a fibroid tumor, I do not 
profess to know. Nearly all agree that the cauterizing, hardening and 
contracting effect of the positive pole is the process by which the tumor 
is reduced, when that pole is used. There is more speculation regard- 
ing the effect of the negative ; but all agree that it reduces a tumor 
more rapidly than the positive. 

Dr. Apostoli thinks its effects are due to an over congestion and con- 
sequent destruction of the molecules. Others believe the tumor is 
composed of certain electrolytes, which are decomposed by the current 
and are then absorbed. 

If I digress further on this point, I would be losing sight of the 
second object of this paper, the results which are obtained. 

These may be divided into two classes. First, the changes noted in 
the pathology ; and second, the change in the symptoms and, the gen- 
eral condition of the patient. One of the first changes in the path- 
ology is the breaking up of the adhesions. The tumor which was 
before immovable, becomes movable. I have also noticed this as one 
of the first changes when treating an ovarian tumor by electrolysis. 
The tumor also begins to decrease in size, which will be recognizable 
both by external manipulation and internal measurements. The retro- 
gression will continue for some months after the treatment is discon- 

I was much surprised on my return to this city this month, on 
examining a patient I had treated last Spring, and who had had no treat- 
ment for two months, to find that the tumor, so far as I could perceive^ 
had decreased in size just as fast while I was away as when under active 

Dr. Apostoli has noted the fact that, under treatment, the tumor 
tends to partially separate from the uterus and become pedunculated. 
This I noticed in two cases in his clinic, and one in my practice, a ring 
of depression at the attachment of the tumor to the uterine wall being 
distinctly felt through the vagina. 

We have much more marked changes in the symptoms and general 
condition of the patient than in the pathology. If it be a hemorrhagic 
fibroid the hemorrhage will almost immediately stop if the positive 
pole is used internally and the patient be able to bear a very strong 

Bureau of Surgery. 97 

Striking as this may be, it is not more so than the improvement in 
the general health and constitutional symptoms. The appetite 
improves, the patient sleeps well, gains flesh, and feels much better in 
every respect. Fat accumulates in the abdominal wall, the local symp- 
toms one by one disappear, and this same good effect will continue, 
under proper treatment, until the cure is effected. 

Although I have never seen a fibroid tumor entirely removed by 
electrolysis, 1 have yet to see a single case that has been under treat- 
ment a sufficient length of time in which every symptom that could 
be traced to the tumor did not disappear, and this relief, so far as I 
know, has been permanent. 

I saw cases in Paris treated by Dr. Apostoli two, three and four 
years ago which were as well as when discharged from the clinic. 

That there are cases which are but slightly or partially relieved, I 
know ; there must be many, only I have never seen one. 

I will not tax your patience longer. I wish to say, in conclusion, 
that success will not be obtained by careless treatment, but only by 
strict adherence to all the minor details and a careful study of each 


By J. G. Gilchrist, M. D., 


The text-books and periodicals, for many years, have had much to 
say of hernia abdominalis. The general interest felt in this subject is 
easily explained and understood when we recall the very serious nature 
of the condition. Whether hernia is recent or ancient, acquired or 
congenital, every movement is one of danger to the sufferer. Accord- 
ingly, for many years, surgeons have been busy devising operations for 
its cure, so that the number of " radical cures " is very large. Some 
of them had a very brief life ; others survived, in spite of portentous 
failures, for a generation or two. Most of them have dropped out of 
sight entirely, but now and then an old method will be revived, modi- 
fied and u improved," but it quickly goes back to oblivion (again). 

98 Bureau of Surgery. 

The earlier idea was that the canal was to be closed up, either by 
invagination, or in some manner by reducing its dimensions, and among 
the majority of operators to-day, the same ends are sought. The opera- 
tion usually results in failure, no matter what the particular method be, 
from a failure to recognize or appreciate the importance of certain 
predisposing conditions, and for the want of proper medicinal treat- 
ment of the case after an operation has been made. It may be stated 
as roughly a fact, that the cause of hernia is not, by any means, to be 
looked for in the patency of the vaginal process, or an unusual size of 
the abdominal rings. Certainly these conditions are important factors 
in the causation, but are rarely, if ever, of such importance that other 
and more potent ones are to be ignored. The chief cause is found to 
be an elongation of the mesentery, practically producing such augmen- 
tation in bulk of the contents of the abdomen, that the capacity of 
that cavity is insufficient. It is true that the loss of support, when the 
canal or its rings are too capacious, favors such traction on the mesen- 
tery, that elongation is, sooner or later, produced ; but with these out- 
lets intact^ if the mesentery, from any cause, becomes elongated, a 
hernia will, nevertheless, appear. There can be no question that a 
radical cure of hernia cannot be secured without closing the canal ; but 
if this is the sole treatment, my experience leads me to state most con- 
fidently, few patients will remain cured. 

It has been my fortune to make very many operations, probably all 
the legitimate ones, even to the very doubtfully " legitimate " Heaton- 
ian. I am of the opinion that my success has been probably as good 
as others, but the number of positive cures has been very small until 
quite recently. For the past year or two the successful cases so far 
outnumber the unsuccessful that I confidently expect, if not an absolute 
cure, at least a marked improvement on the former state. The proced- 
ure, as far as the instrumental part is concerned, varies slightly in 
different cases, but is generally as follows : 

The part is shaved quite closely, and a fold of the integument 
pinched up over the external ring and transfixed with a curved bis- 
toury, making an incision of from an inch to an inch and a half in 
length. The fat which now appears is broken through with the finger 
or the handle of a scalpel, or incised, if necessary, and the incision 
deepened until the ring is brought into view. Now if the sac is not 
too voluminous, or too much thickened, it is pushed up into the canal 
until the lower portion, at least, is fairly filled with it. A needle 
armed with catgut — carbolized or not is a matter of utter indifference 
— is entered into the mass of the sac and brought out well beyond the 

Bureau of Surgery. 99 

pillar on either side ; the needle is unarmed and armed again with the 
other end of the catgut, and used in the same way on the other side. 
The ligature is then drawn tight, knotted, and the ends cut off, bring- 
ing the pillars together, and retaining the plug formed by the sac 
in the canal. This stitch is taken in about the middle of the pillars. 
Should the ring be very large I freshen the edges with scissors or 
knife, and insert two or even more stitches. Should the* sac be vol- 
uminous and too vascular, after stitching it in the canal it is ligatured 
by transfixion and cut off. Up to this point there is little, if anything, 
peculiar or novel in the operation, nor in the closure of the external 
wound, which is by means of interrupted sutures of silk. Over the 
wound I place a compress of absorbent cotton, saturated with a solu- 
tion of Hypericum, about ten drops of tincture to two or three ounces 
of water, securing it in place, as well as furnishing support to the parts 
by a snugly applied spica bandage. The patient is then put to bed, 
Cautioned to apply the hand over the wound in coughing or vomiting, 
as well as in urinating or going to stool. The compress is not to be 
wet with the Hypericum again, but the remedy is given in any dilu- 
tion, the thirtieth preferable, about once an hour. After twenty-four 
hours have elapsed, the bandage and compress are removed, a dry com- 
press applied and a new bandage put on ; the Hypericum is to be con- 
tinued for two or three days longer. When the external wound is 
fairly healed a light truss is to be applied, one with a flat pad, with 
either a very weak spring or elastic straps, and the patient permitted 
to go about the house. In fact, he can usually leave the bed for a 
chair about the fourth or fif *h day, but must be careful to apply the 
hand over the wound while moving from chair to bed. About the 
tenth day he may leave the house, never without the truss, which 
should be worn until the parts are evidently healed. The truss is to 
be worn during the day, and after lying down at night must be 
removed. In the morning it must be replaced before rising. These 
rules are imperative. After the third ox fourth day, as soon as the 
Hypericum is discontinued, commence giving Lycopodium 80 three 
times a day for two weeks, then twice a day for two weeks, afterwards 
once a day until there is evidently no disposition to a reappearance of 
the hernia. This item in the treatment I esteem sine qua non. I was 
led to employ this remedy on the authority of the late Dr. Holt, of 
Massachusetts, the first case being as follows : 

A young man had a large inguinal hernia on the left side, which 
came down into the scrotum whenever the truss was removed. It had 
never been straugulated, but his truss not being comfortable, he applied 

► - : *a: ml *•• ± •; ' 
i • ■'; i. *?<' t •■ * ■■ 

MO Bureau of Surgery. 

for a radical care. The operation was made, as above, and for a time 
all seemed well. After about six weeks a bubonocele appeared on the 
right side. Recalling Pr. Holt's experience, I gave Lycopodium 30, 
purposing to make a second operation at a later period. The bubon- 
ocele disappeared, and during the two or three years I had him under 
observation, did not return. 

A second case was one of double inguinal hernia, that on the left 
side being dpuble the volume of the right. A double operation was 
made. The left hernia did not again appear, but after a time that on 
the right became prominent. Lycopodium was given as above, and all 
trouble passed away. 

There are many such cases in my case-book, and finally the question 
naturally arose, why wait for the reappearance of " the hernia? Accord- 
ingly it became a habit to give Lycopodium as a matter of course, and 
the result in about forty cases seems to justify the practice. In my 
last fifty cases, as far as I have been able to learn, there has not been 
one that has not been vastly improved, and the large majority (thirty- 
four) may properly be claimed cured. 

There can be no doubt that the desirable shortening of the mesen- 
tery is secured by giving the Lycopodium. 



By George Allen, M. D., 


Peroxide of Hydrogen, Hydrogen Dioxide, Oxygenated Water, 
H 3 2 ; such are the chemical names for the substance to which your 
attention is directed in the present paper. In the pure state it *is " a 
colorless, syrupy liquid," having a disagreeable metallic taste, slightly 
caustic properties, and possessing the power of bleaching the tissues 
with which it comes in contact. 1 u The various bleaching agents used 
to convert brunettes into blondes are dilute solutions of oxygenated 
water." l u In the pure state it is very unstable and decomposes at 

1 Witthaus' Medical Chemisty, p. 67 and 68. 

Bureau of Subobey. 101 

ordinary temperature ; diluted with water, however, it is 1 compara- 
tively stable and may be boiled or even distilled without suffering 

Hydrogen peroxide was discovered in 1818 and has been used in the 
arts since that time ; it is only within a few years, however, that it 
has been used in medicine. 

Philips 8 says it has a marked antiseptic power and quotes Guttman 
to the effect that urine mixed with one-tenth of Peroxide remained nine 
months without putrifying action. A recent writer in the Medical 
Hecord? says of Hydrogen peroxide : " Recent investigations seem to es- 
tablish its claim as one of the most potent destroyers of bacterial life. 
" Careful comparative tests prove it to be sixty times as powerful as 
" Carbolic acid, twenty times as strong as Salycilic acid, and 40 per 
" cent, more potent than the solution of the Bichloride of Mercury." 
The writer still further says that " extraordinary as this may seem 
experiments place it beyond a doubt." Nothnagel & Rossbach 4 
affirm that " the secretions from chancres and buboes loose their infect- 
" ing power in the presence of Hydrogen peroxide in somewhat large 
" quantities." The action of this agent on pus is remarkable. If a 
few drops of a 10 per cent, solution be brought in contact with pus a 
brisk effervescence ensues, which continues till all the pus is com- 
pletely destroyed. The same action occurs in the presence of yeast, 4 
various ferments, freshly drawn blood and diphtheritic membrane. 
The effervescence noticed is due to the decomposition of the Hydrogen 
dioxide and the yielding up of one equivalent of oxygen. This 
equivalent of newly liberated oxygen being in the " nascent state " 
possesses more active properties than usual and rapidly oxidizes the 
organic substances with which it comes in contact, thus destroying pus, 
bacteria, fungi, etc. To this powerful oxidizing property, therefore, is 
due, doubtless, its great efficiency as an antiseptic. 

Its uses thus far have been directed to the cleansing of foul ulcers, 
and to a limited extent in ottorrhcea, purulent and diphtheritic ophthal- 
mia and gonorrhoea ; also as a local application in diphtheria. Dr. C. 
F. Sterling 6 in a paper before this Society in February, 1885, spoke of 
the value of this agent in purulent inflammations of the middle ear. 
My own attention was called to its use by Dr. H. M. Paine, the honored 
President of this Society, from whom I obtained the first specimens for 
use. This was an aqueous solution of "ten volumes" containing 2.1 

1 Witthaus' Medical Chemistry, pp. 67 and 68. 

2 Materia Mediea— Inorganic Subs. Vol. 1, p. 16— Wood's Ed. 

3 J. Mount Bleger in Med. Kec, Aug. 13, 1887. 

4 Mat. Med., Vol. 1, p. 310— Nothnasrel & Rossbach. 

5 Trans, of the Horn. Med. Soc. of the State of N. Y M Vol. XV, p. 218. 

102 Bureau of Surgery. 

per cent, of H 2 8 , and in my practice has been still further diluted 
before using by the addition of twice its bulk of water, making a 
strength of about one to three of a ten volume solution. 

Dr. Paine writes concerning it : "I always use it at fir3t, in every 
"case of ulceration. When the secretion of pus ceases 7 I usually 
" change for some other remedy, frequently Iodoform, hence " I can- 
not report as to its positive effects." My object in this paper is to 
speak of the very great value of this agent in the treatment of 
abscesses of every sort. I have used it as follows : After opening an 
abscess and allowing the pus to escape, the cavity is filled with a 
solution of the Peroxide of Hydrogen, from a syringe. A brisk effer- 
vescence ensues as the fluid escapes, and this continues till all the pus is 
destroyed. No pain is experienced from its use in this strength. The 
result in my cases was that the secretion of pns diminished rapidly 
from the first application of the remedy — the cavity in every case 
closed with corresponding rapidity, so that a large abscess whose 
closure, by ordinary treatment, would be a matter of weeks, was brought 
to a termination in a few days. The following cases are illustrative of 
its action : 

Case I. Phlegmonous erysipelas of both legs. An abscess formed 
in each, which discharged on opening about a coffee cup of thin, 
dark, sanious pus. The abscess which first appeared was washed out 
with a solution of Bromine for two days, but the secretion of pus 
continued to be profuse and the cavity remained the same size. 
The Bromine was then discontinued and a solution of Peroxide of 
Hydrogen substituted. After the first injection there was scarcely any 
further secretion of pus, though the cavity was washed out daily with 
the Peroxide solution. It rapidly diminished in size and was practically 
closed within a week. 

Case II. "Was on the other leg of the same patient. The Peroxide 
solution was used as soon as the abscess was opened. The result was 
equally rapid and satisfactory as in the first case. These abscesses 
occurred in an alcoholic patient, one of that class of cases in which 
there usually occurs a considerable sloughing of cellular tissue, and 
whose progress is apt to be slow and tedious. Under use of the Per- 
oxide of Hydrogen there was no sloughing of cellular tissue whatever, 
and the progress of the cure was neither slow nor tedious, but on the 
contrary, very ra pid and highly satisfactory. 

Case III. Was a large abscess, located in the left side of the 
pelvic cavity. From this location the pus burrowed among the tissues 
of the abdominal parietes and found exit through the right lumbar 

Bureau of Subgery. 103 

region. The sinus which connected the abscess with the opening 
was about twelve inches long. A rubber drainage tube was intro- 
duced through the sinus, and the abscess washed out daily with 
a solution of Peroxide of Hydrogen, followed by one of Carbolic 
acid. This case was an unusually bad one to manage on account 
of the great length of the sinus. Under the treatment pursued, how- 
ever, the pus, from having been horribly offensive, lost its offensive char- 
acter, and in a few days, became entirely laudable and greatly dimin- 
ished in quantity ; the constitutional symptoms, which had been alarm- 
ing, disappeared and the abscess closed in a much shorter time than it has 
been my lot to witness in other similar cases. To be sure Carbolic acid was 
used, but never have I seen this * agent produce such marked and 
rapid changes as were seen in this case ; so that it seems reasonable 
to attribute the results obtained to the use of Peroxide of Hydrogen, 
especially as they are entirely in harmony with those obtained by the 
use of this drug in other similar cases. 

Case IV. Is one which I am enabled to report through the 
kindness of a brother practitioner 6 and as the Peroxide was the 
only agent used, the case is all the more valuable as illustrating the 
positive effects of the drug. 

P. M., a male aged twenty years, ha<} a large abscess extending from 
the clavical on the right side downward as low as the tenth or eleventh 
rib, apparently lying under the pectoralis major muscle and over the 
serratus magnus anticus and external oblique abdominis. Free 
incision was made, and gave exit to from sixteen to twenty ounces of 
pus (estimated). An oakum pad was applied, as the only dressing. 
Two days later a solution of Peroxide of Hydrogen (10 vols.) diluted 
with water in the proportion of one drachm to twelve ounces (about 
1 to 100) was injected into the abscess from a fountain syringe. There 
was no difficulty in injecting about eight ounces at this time. Two 
days later only one ounce of a similar solution could be injected. 
This Peroxide preparation was used only four times, at intervals 
of about two days, and was the only fluid injected. At the end 
of this time the abscess had healed and the opening closed. This 
case occurred in an anaemic poorly nourished subject, phthisically 
inclined, and was a very unpromising case 60 far as the expectation of 
a speedy recovery was concerned. The solution used was very, dilute, 
but the results were none the less prompt and satisfactory. I have 
also used the Peroxide as an application to lacerated wounds 
and ulcerated surfaces, when suppuration was profuse, with the reault 

e Dr. C. Wilaon, Waterville, N. Y. 

104 Bureau of Surgery. 

in every case of diminishing the suppuration and promoting the healing 
process. Dr. Paine speaks of its value in ulcerations and abrasions of 
the 08 uteri. 

From the foregoing, therefore, I am led to conclude that in the 
Peroxide of Hydrogen we possess an agent of great value for the treat- 
ment of suppurative processes of every kind, and particularly for the 
treatment of abscesses. 

The Before and after Treatment of 


By H. I. Ostrom, M. D., 


Laparotomy has become a surgical fashion. Surgeons seek to demon- 
strate' that the majority of pelvic lesions are amenable to operative 
treatment, and that the abdomen can be opened, its contents examined 
and neoplasms removed with little more than ordinary surgical risk. 
The newness of the operation and the brilliancy of the results obtained 
have naturally led to its somewhat indiscriminate performance, but 
abdominal surgery now rests upon too firm a basis, and the benefits 
conferred upon our art by the pioneers in this department of surgery 
are too well recognized, to require defense at this time. If some lives 
have been sacrificed to a principle, more have been saved from a life 
of suffering, or from death itself ; and the names of Wells, Thornton, 
Keith, Tait and a score of others, will remain as monuments of cour- 
age and personal sacrifice, and as synonyms of " healer of the sick." 

Within its brief history abdominal surgery has made phenomenal 
progress. The success which to-day attends the various operations that 
may be classed under that head, was, even in the prophetic brain of 
McDowell, scarcely dreamed of. The causes that have led to this suc- 
cess are the same that influence general operative surgery ; the same 
that make it possible for Victor Horsely to diagnose and successfully 
remove cerebral neoplasms; the same that enables you and me to under- 
take with some degree of confidence and with comparatively little fear 


Bureau of Surgery. 105 

of inflammation and septicaemia, operations which would have caused 
surgeons of a century ago great anxiety and possibly bitter disappoint- 
ment. • 

As we study the early work of Sir Spencer Wells, — I refer to him 
because he was among the first who made a speciality of abdominal 
surgery, — *),nd that of his more successful colleagues, we receive the 
impression that the practical application of general science, if I may 
be allowed the expression, the catholicity of modern surgery, is directly 
associated with our present low mortality rates. All science is one. 
The impetus given to the surgery of to-day is derived from histology, 
biology and chemistry, each branch of learning contributing to the 
general fund. The mental activity which we see on every side and 
and in every walk of life, the general desire for scientific investigation 
knowledge, almost unprecedented in social history, the craving for 
original research with which the latter part of the nineteenth century 
is redolent, are the matrix out of which is born our improved instru- 
ments, our better methods of operating, our aseptic and antiseptic sur- 
gery. Not to the surgeon alone is credit due for his unerring skill in 
reaching disease, and the impunity with which he seems to defy organic 
structural laws. Mr. Tait must share his honors with Darwin, Spencer, 
Tyndal, Pasteur, or any other collaborator, who, by adding to science, 
has made his success in abdominal surgery possible. 

But while all that pertains to the operation itself will of necessity 
influence our successes and our failures in abdominal surgery, the treat- 
ment before and after the operation are important factors in contribut- 
ing to the results which astonish the world, and of which we, knowing 
more truly their significance, may justly feel proud. Here, also, 
the broad scientific knowledge of the day is perceptible, and of this 
not so much talked of question I would ask your consideration, more 
for the purpose of eliciting discussion and obtaining the views of 
operators of more experience, than with the intention of advancing 
either new opinions or adding to the well-nigh perfect methods now 

The treatment before an abdominal section will, it is scarcely neces- 
sary to say, be in the direction of preventive medicine, and designed 
to prepare the system against shock and to enable it during convalescence, 
to continue the balancing between waste and repair which constitutes 
normal functional activity. This is true of all operative surgery, but 
becomes more especially so as the gravity of the case increases. 

In this connection — the treatment before the operation — our atten- 
tion is first directed to the organs of elimination, and of these the 

106 Bureau of Surgery. 

kidneys urge prior claimfe for consideration, not only because of the 
function they perform, that of removing peculiarly poisonous material 
from the swteni, but also because of the frequently masked diseases 
that exist in these organs, and the developing or aggravating action which 
sulphuricether exerts upon such diseases. In the light of recent investi- 
gation, there is little doubt that some cases of sudden death during or 
within a few days after an operation, are due to a defective action of the 
kidneys, an action that in an undetected degree antidates the operation, 
but probably as frequently is excited by the nervous condition that 
precedes the operation, or by the ether used for anaesthesia. Shock 
and uraemia resemble each other quite closely, and when the condition 
of the kidneys is not known one may be mistaken for the other. 

To ascertain the true condition of the kidneys it is necesssary to 
examine the urine during several days before an operation, and for a 
corresponding length of time after the operation. Probably if surgeons 
would adopt this plan and make themselves more familiar with the gen- 
eral condition of their patients th^ r would be better able to meet indi- 
vidual complications as they arise, accidents in the operating room 
would be less frequent, and the statistics of our graver operations would 
be even more encouraging than they are at present. 

The anaesthetic used, and the method of its administration are im- 
portant factors in the before treatment of laparotomy. Of the two 
anaesthetics, ether and chloroform, the former is regarded the safer. 
This is certainly true, if we consider the suddeness with which the 
lungs and heart cease to act under the less used vapor. There is no 
question that a fatal dose of chloroform is more quickly and more 
insidiously reached than one of ether : but in view of the known 
effect of ether upon the blood, and upon the kidneys, has not our 
rejection of chloroform been too general ? Should we not select our 
anaesthetic in accordance with the condition of the patient? Where 
there is suspicion of a kidney lesion would we not run less risk from 
the general depression of chloroform than we encounter from the- 
nephritic action of ether ? By careful watching, — one of the most 
trustworthy signs of safe chloroform narcosis is to be found in the con- 
dition of the pupil — we should be able to anticipate the stages of dan- 
ger ; but if ether is given, and there is a kidney lesion, we not only run 
the risk of accelerating that disease, but we possess no means of ascer- 
taining the extent of the injury until after the injury has been done. 
I do not wish to advocate the substitution of chloroform for ether in 
abdominal surgery, but I believe that in some cases ether is, less free 
from danger than chloroform. These cases may be few, they are cer- 

Bureau of Subgery. 107 

tainly exceptions, but their existence should cause us to hesitate before 
subjecting our patients to an unnecessary danger, and one that could 
possibly be avoided. 

The defective oxygenation of the blood which ether causes, we may 
conclude, is increased by the quantity of ether given, and will continue 
in proportion to the length of time that a person is under its influence. 
With the smothering method of administering ether, the minimum 
quantity is less likely to be exceeded, than when the early stages 
of anaesthesia are prolonged. From the former practice I have seen 
no ill effects ; from the latter I have not been so fortunate. The 
danger of both ether and chloroform, as of any other poison, 
lies in the lithal dose, and when we recognize this fact, and regulate 
our use of these powerful drugs accordingly, we will have fewer acci- 
dents that can be traced to anaesthetics. 

The fear that prevailed half a century ago of interfering with the 
abdomen and its contents, has been replaced by the belief that the sur- 
gery of this region of the body should be conducted upon the same 
principles that govern operations generally. Thia rational conception 
of abdominal surgery has developed a corresponding rational concep- 
tion of its after treatment. The woman who has undergone abdom- 
inal section is insured absolute rest for a few days. Her digestive 
organs having been more or less disturbed, are given nothing to do for 
twenty-four hours. At the expiration of that time, if there is no 
nausea, the hot water is replaced by simple broth, or some form of 
inilk food. I find that unadulterated milk is not always well borne 
in abdominal surgery. It favors constipation, a condition to be avoided, 
and gives rise to flatulence, a most distressing and dangerous complica- 
tion. As a substitute for milk I have laterally used barley water diluted 
with one-third cream with very gratifying results. At the end of 
the first week, or possibly earlier, the patient generally receives easily 
or partly digested semi-fluid food, gradually returning to her normal 

Some difference of opinion exists among operators whose experience 
is equally deserving of attention, concerning the treatment of the intes- 
tinal canal after laparotomy. The former weight of opinion wad in 
favor of enforcing a suspension of activity until convalescence became 
fairly established ; the wisdom of this practice is now very generally 
questioned, some surgeons advising the administration of a brisk 
saline purgative on the third or fourth day after the operation. Each 
surgeon must, to a certain extent, think for himself, and practice his 
own surgery, and while I do not criticise either the methods or results 


of other operators, I am forced to say that I believe this interference 
to be only exceptionally called for. Both theoretically and practically 
I find no reason for denying the intestinal canal the same rest that we 
seek to give other parts of the system. If the bowels have been 
thoroughly emptied before the operation, — and the length of time nec- 
essary to accomplish this will surprise one, — the food for the first few 
days cannot leave any troublesome residuum in the intestinal canal. 
Why then should we be so eager to force it into activity ? Mr. Tait, 
one of the advocates of this practice, says, to drain the abdominal 
cavity. It may serve that purpose in his hands. But when the opera- 
tion is of such a nature as to require drainage is it not better to pro- 
vide a mechanical exit for the fluid, than to throw unnecessary work 
upon the peritoneum and the abdominal organs ? Best is one of the 
elements of repair, and as a routine practice I have never seen occa- 
sion for so early disturbing the inaction of the bowels that usually 
follows a laparotomy. If peritonitis threaten, with distention of the 
abdomen, a purge, especially calomel, will, by acting upon the portal 
system, do much towards averting the threatened danger, but we would 
then be dealing with quite another question from that of simply mov- 
ing the bowels. If, in a week or ten days, the diet then being quite 
liberal and containing solid food, there is no disposition to stool, an 
enema may be given and repeated until effective, but I do not believe 
in the efficacy of inducing a purgative action of the bowels in ordi- 
nary cases of laparotomy. One of the most alarming cases I have ever 
had, developed within a few hours after administering a purge. The 
lady, — it was a case of hysterotomy, — was doing well, but on the 
fourth day, the bowels being inactive, I ordered a mild purge. The 
result was collapse, followed by peritonitis, and a prolonged convales- 
cence, which I think could have been avoided. It is desirable to pre- 
vent any great accumulation in the intestines, but the food taken is of 
such a digestible character that this is not likely to occur within the 
first week or ten days. 

The management of flatulence, one of the most constant, troublesome 
and in some instances dmgerous complications of abdominal section, 
will sometimes tax our utmost skill. In a great measure the diet for 
the first forty-eight hours will help to control this symptom ; we can 
scarcely expect to prevent it. Hot water given ad libitum, sometimes 
in sufficient quantities to cause emesis, is of service. It is a mistake to 
leave the stomach entirely empty, for this condition in itself is suffi- 
cient to generate flatulence. 


Bureau of Subgsbt. 109 

Change of position will frequently relieve flatulent accumulation. 
Turning from one side to the other, or from the back to the side, will 
not only relieve the colic, but liberate the gas. There is nothing in the 
operation of laparotomy that should prevent a patient from assuming 
any position that conduces to her comfort, or to change her position, — 
of course with assistance, — as often as she feels the desire to do so. In 
simple cases, the bed rest affords marked relief; I have allowed 
patients to sit in a half reclining position as early as the third day 
after the operation. Among medicines to relieve flatulence, Bella- 
donna, Colocynth, Colchicum and Nux. vom. are invaluable. The latter, 
I have found to give prompt relief. The rectal tube, worn for a length 
of time, must not be neglected, nor the efficacy of enemas forgotten. 
When the gas seems to be generated in the stomach, a soft oesophagael 
bougia passed through the pyloric opening will afford temporary relief; 
and this is important in severe cases. 

The causes of flatulence after abdominal section are probably in a 
measure nervous, it being one of the symptoms induced by the shock 
which the system has sustained. I have found it developed to a distress- 
ing degree after trachelorrhaphy, and perineorrhaphy, and several times 
after a simple amputation of the breast. In such cases there is nothing 
alarming in the condition, but when it follows upon an abdominal sec- 
tion, the seat of the surgical lesion favors the development of serious 

With the exception of the twenty-four hours succeeding a laparot- 
omy, the bladder usually requires no active interference with its func- 
tions. , The effect of ether upon the blood causes a degree of conges- 
tion of the kidneys, which generally induces a temporary suspension of 
their action. There is therefore not the usual quantity of urine 
secreted. There is also frequently a spasm of the urinary sphincter, 
which interferes with a voluntary emptying of the bladder. This state 
of scanty urine, and inability to urinate, together with the importance 
of ascertaining the condition of the kidneys, will of course be met by 
catheterization, but as soon as the patient is able to urinate, she should 
be allowed to do so. The practice of using the catheter at regular in- 
tervals for several days, is, as a rule, quite unnecessary, and is liable to 
give rise to a painful and troublesome form of cystitis. When an in- 
ability to empty the bladder continues unduly, the u nervous spell" is 
sometimes broken by allowing the patient to sit on the vessel in bed 
once or twice ; after doing so, she is generally able to use the bed pan, 
or urinal. 

110 Bureau op Subgeby. 

Nausea and vomiting are exceptionally absent after laparotomy, and 
are as difficult to control. Since the use of the clamp has been re- 
stricted almost entirely to hysterectomy, these symptoms have possibly 
become less f reqnent, but they are still sufficiently common to prove 
formidable obstacles to rapid recovery. 

Apart from the general causes, disturbance of the abdominal viscera; 
and nervous shock, I am led to believe that this very troublesome com- 
plication is connected with the quantity of the anaesthetic given, and 
with our method of dealing with adhesion. Of the former I have 
already briefly spoken, but I will here add, that in general surgery I have 
observed nausea and vomiting to follow more constantly and be more 
persistent when Ether has been given slowly, than when the mini- 
mum dose was administered. Though my opportunities for making 
observations in abdominal surgery have necessarily been more limited, 
I have here been led to the same conclusions, as those derived from 
other operations. 

The constriction of tissues within a ligature, is credited with causing 
nausea and vomiting; when adhesions are numerous and are dealt 
with in that way, the probability of exciting reflex nervous action, is 
to that degree increased. Mr. Tait, who depends largely upon dry 
sponging to control hemorrhage from pelvic adhesions, never using a 
ligature unless absolutely necessary, says that nausea and vomiting are 
rarely troublesome complications of his later laparotomies. May we 
not therefore question, whether the ligature is not applied with unnec- 
essary frequency, to abdominal adhesions ? Dry sponging and a more 
frequent use of the actual cautery, would lesson the number of liga- 
tures necessary to control hemorrhage ; and if these are a cause of nau- 
sea and vomiting, would it not be well, when possible, to use other 
means to accomplish the same end ? 

In the removal of uterine fibroids, and in amputation of the uterns 
itself, Mr. Baker Brown, and more recently Dr. Keith, have demon- 
strated that the power of the actual cautery to control hemorrhage 
may be depended upon. The vessels cut in the former operation, 
especially those which enter into the pedicle, are large, but generally 
have little contractile power, the blood therefore flows, rather than 
spurts from them. In consequence, the eschar has not so much force 
to resist, as from the same sized vessel in other neoplasms. 

In a recent laparotomy for the removal of a sub-serous fibroid, I had 
an opportunity to test the power of the cautery to control the character 
of hemorrhage of which I have spoken. I tied the pedicle, which was 
short and thick, with a Staffordshire knot, intending to close it over 

Bureau of Surgery. Ill 

with peritoneum, but almost immediately after cutting off the tumor, 
the pedicle retracted, leaving a depression in the uterus, from the base 
of which two large arteries poured out an alarming quantity of blood. 
It was impossible to ligate the vessels, and any attempt to close the 
uterine wound resulted in more laceration, and increased the hemor- 
rhage. I applied the Paqnelin cautery, producing a large eschar, 
with the effect of promptly controlling the hemorrhage. The case 
progressed uninterruptedly to a perfect cure. 

Frequent sips of hot water, 6eem not only to prevent, but to relieve 
nausda. When there is constant vomiting, it may bo well to administer 
large quantities of water and produce very copious emesis, to relieve 
the irritation of the continued fruitless contraction of the stomach. I 
have never seen any advantage from an admixture of brandy with the 
hot water. The remedies given are numerous. I think I have had 
the best results from a 2 percent, of Cocaine. Sometimes nausea will 
persist until the clamp is loosened, or the deep abdominal stitches 
removed. The truth is, nausea and vomiting are among the bete 
noirs of abdominal surgery, and every case that proves obstinate to 
treatment, must be studied individually, and step by step of the opera- 
tion reviewed, to, if possible, ascertain the causes of the gastric dis- 

We now come to the question of using Morphine after a laparotomy. 
In the early days of abdominal surgery it formed a constant part of 
after treatment ; the most successful operators now use it sparingly, 
and never unless the necessity for quiet and sleep are urgent. The 
generally depressing effect of this salt, has led to its present restricted 
use ; the wisdom of the change in practice can not be doubted. I have 
not found that patients generally suffer acutely after they have fully 
recovered from the anaesthetic. Their suffering is more from nervous 
depression, and calls for a stimulant rather than for a depressant. If any 
narcotiq is necessary, Opium will answer a better purpose than Mor- 
phine, in abdominal surgery. Aconite and Hypericum, or the latter 
alone, will relieve pain, and quiet the nervous system. After no oper- 
ation do my patients receive Morphine, if they can possibly get along 
without it, and they frequently do get along without it, by careful 
nursing, and the use of Aconite and Hypericum. I do not wish to 
oppose myself unconditionally to the use of Morphine in abdominal 
surgery ; it is one of the greatest remedies that our materia medica 
contains ; but in proportion as it is of use, it may be most harmful, 
when indiscriminately given. Because a person has undergone a 
severe operation, is not a sufficient excuse for giving Morphine. When 


112 Bureau of Surgery. 

they begin to suffer, and when they require quieting, will be early 
enough to administer narcotics. 

In this very brief consideration of the before and after treatment 
of laparotomy, I have made no attempt to cover even the simple cases 
of abdominal section. The complicated cases, and we know how fre- 
quently these occur, must be met by all the skill and experience that the 
operator can summon ; and notwithstanding these, and without apparent 
reason, the result is sometimes failure. No branch of surgery is more 
taxing upon the surgeon, none more unjustly criticised by laymen, and 
in none should there exist more professional charity. 

bromine as an antidote for dissecting 

and septic Wounds. 

By M. O. Terry, M. D., 

una*, n. y. 

I have had poisoned fingers so many times and have been relieved 
so speedily on these various occasions by the use of Bromine, that I 
feel I shall be a Good Samaritan to surgeons wherever they may 
reside, to the unfortunate physician, as well as to the student in the 
dissecting room, if I re-impress this old remedy op your minds in a not 
Unknown light, namely : its value as a remedy in poisoned wounds. 

It has been considered valuable and used quite extensively in gangrene 
and phlegmonous erysipelas. 

Perhaps one of the most practical articles on the subject referred to 
is that of Dr. Geo. Allen's, of Waterville, printed in Vol. XVIII of 
the Transactions of this Society. But brevity is the soul of wit and I 
wish to make this article so short, yet impressive, that it cannot be for- 

It was soon after I had been poisoned by operating on a malignant 
case of diphtheria that I noticed the death of a prominent Brooklyn 
surgeon, poisoned in the same manner. 

This case, together with numerous ones of wounds which have come 
under my notice, directly or indirectly, that were tedious in healing 
and dangerous in character, has caused me to direct your attention to 
a remedy of wonderful activity and reliability. 

Bureau of Surgery. 113 


You may theorize as you like in regard to how Bromine acts and why 
it is superior to other agents like Carbolic acid or the cautery. It has 
seemed to me, however, that its intrinsic worth depends principally on 
two properties, namely : its power to penetrate tissues and to coagulate 
albuminoids in a thoroughly antiseptic manner. It not only, therefore, 
forms a coating over the poisoned surface of the wound, but destroys 
the germs of the diseased part. It has another characteristic — it arrests 
the inflammatory action, the abnormal heat disappears and with it the 

Bromine should always be kept in solution in a glass stoppled bottle 
in the surgeon's office. It can be prepared in the following manner : 
Into an eight ounce bottle put about a drachm of Iodide or Bromide 
of Potash, one ounce of pure Bromine and then fill with water. When 
necessary to use it — for a poisoned finger for instance — pour about a 
drachm into a glass and fill one-third with water. Insert finger for 
some distance beyond the wound for a few moments and repeat every 
three or four hours. Occasionally one application is sufficient. No 
surgical dressing is necessary. 



By Sidney F. Wilcox, M. D., 


The operation of wiring the patella has not been looked upon as one 
giving the most brilliant results. The old superstition regarding the 
danger of opening the knee joint, like that of opening the abdomen, 
has not yet died out. The fear of setting up a suppurative inflamma- 
tion in this large joint, and the consequent bad results which may fol- 
low, still exists. But with thoroughly antiseptic methods it has been 
demonstrated that the knee joint is as tolerant of operative interfer- 
ence as any other portion of the body. 

If I had no other ground on which to base my opinion, a certain 
experience in operating upon this joint would make me a thorough 
convert to the " antiseptic method" By this I mean antisepsis thor- 
oughly carried out without omitting the slightest detail, either in the 

•'87 'V '"*V-£7*-^\*iV*?*. 

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r-" • ' f ' 

&*>'•■ ,' 11* Bureau of Surgery. 

preparation for, or the performance of, an operation. Also I must 
insist, to make my ground sure, that not only the operator, but also 
his assistants, must exercise the most scrupulous care to the end of abso- 
lute asepsis. 

Still even under Lister himself, there has been one unsuccessful case, 
and even with the best of favoHtble conditions, one cannot promise 
perfect immunity from danger. 

The majority opinion with regard to this operation may be briefly 
stated as follows : That on account of the good results as regards useful 
limbs under conservative methods of treatment, it is, as a rule, unneces- 
sary to employ an operation which may be fraught with danger. 

The exceptions to this rule may be : 1st. Where there is a compound 
fracture with an opening into the joint. 2nd. Where there is a com- 
minuted fracture to such an extent that it is impossible to draw the 
fragments together by external means. 3d. Where there is so much 
laceration or contusion of the tissues about the joint that external 
means cannot be employed, and 4th, where, by the conservative meth- 
ods, only a weak or inefficient ligamentous union has been obtained. 
To this last class belongs the case which 1 shall detail. 

The safety of a secondary operation is greatly enhanced by taking 
advantage of a fact, noticed by Dr. Van der Meulen, a that in the 
space between the two fragments of a broken patella, a clot of blood 
is formed. This clot is not organized at once in its entirety, but the 
anterior and posterior surfaces are first organized, and only after some 
time does the process involve the central portion. In this way the two 
fragments come to be united by two thin pseudo-membranes." 

The author takes advantage of this in his treatment of fractured 
patella. From ten to twenty days after the injury, he proceeds to 
operate. An incision having been made over the patella, the anterior 
membrane and the unorganized coagulum lying beneath it are removed ; 
but the posterior membrane is not interfered with, and thus the joint 
is not opened. The fragments are then united by platinum or silver 
wire suture, care being taken not to include the membrane of organ- 
ized coagulum, but to let it fold upon itself posteriorly towards the 
joint cavity. Dr. Van der Meulen has operated in this manner in three 
cases of fractured patella, and has been enabled to obtain excellent and 
firm union. 

(Medical Record, September 6, 1884, abstract from Deutsche Medi 
cinal Zeitung.) 

This operation of Dr. Van der Meulen's is of great practical value 
in a secondary operation, as the actual opening of the joint cavity may 

. ». _, .— . i - 



Bureau of Surgeby. 115 

be avoided. This I found to be true, for in the case I am about to 
relate, I found that by carefully removing the bone from the articular 
cartilage, a membrane was left continuous with this cartilage, stretch- 
ing from one fragment to the other and covering the joint. 

In the first operation this membrane was nicked through in one or 
two places, but without giving rise to any bad result, as the record will 

Case, Mrs. C, set. about forty-five; widow; a very large stout 

History — On May 15, 1886, slipped while coming down stairs. Sent 
for her physician, who diagnosed rupture of the tendon from the right 
patella. Treated with plaster of Paris bandage and was able to attend 
to her household duties after a few weeks, until August 15, 1886, 
when she slipped and fractured patella of the opposite (left) limb. 
This was also treated with plaster of Paris bandage by the same phy- 
sician, and after several weeks, he insisted on her attempting to walk, 
supported by himself and her sister. On attempting to sit down after 
the trial, the right patella broke the second time, and was treated for 
two months by confinement in a plaster of Paris splint, when, becom- 
ing dissatisfied, she had it removed and called in Dr. C. A. Walters, of 
Green Point, who found the joint in a highly inflamed condition from 
the splint. 

Dr. Walters did not think a useful union could be obtained but 
attempted it, after reducing the inflammation, but without result other 
than a weak ligamentous union ; and in April he asked me to oper- 
ate on her at the Hahnemann Hospital. She entered the hospital on 
the 2l8t of April of the present year, and on examination I found that 
she was entirely unable to walk or to stand on account of the weak, 
thin, ligamentous union of the fragments on both sides. She remained 
with the limbs constantly extended, and the least attempt at flexion 
caused her pain and great terror for fear of a re-separation of the frag- 
ments. There was a depression sufficiently wide and deep in either 
patella to lay one's finger in, and so far as any power of locomotion 
was concerned the woman was entirely helpless. 

The first operation was performed on April 22, 1887, and the second 
on the 23d of May. 

As the method of operating on both limbs was essentially the same, 
one description wjll serve for both. 

The day previous to the operation I went to the hospital, selected 
my instruments, and placed them in the pans on the operating table. 
About a dozen towels and a piece of rubber tissue were placed in a 


basin of 1-1500 solution of Corrosive sublimate and allowed to remain 
soaking over night. About an hour before the operation, the instru- 
ments in the pans were covered with a 1-40 solution of Carbolic acid. 
The patient's limb was well scrubbed with soap and a solution of Cor- 
rosive sublimate, and shaved before the operation. After the patient 
was thoroughly anaesthetized, some of the towels which had been soak- 
ing in the solution before mentioned were spread on the table, over 
the opposite limb and over the limb to be operated upon, except about 
where the incision was to be made. 

The incision was semi-lunar, running from one side to the other, 
about three inches in length, and running about $ of an inch below 
the point of fracture. This was made in this way to get more room 
and also that the cicatrix would not come directly over the line of 
union in the bone. The flap was dissected back sufficiently so that the 
patella could be raised with a strong vnlsellum forceps. A track was 
made for the saw through the periosteum, and the bone being raised, 
a thin shaving was sawn from the upper edge of the lower fragment, 
being very careful to divide only the osseous tissue with the saw, but 
not to go into the joint, the bone being carefully removed, leaving the 
membrane on its under surface intact. A shaving was removed from 
the upper fragment in the same manner. All this time, and during 
the subsequent steps of the operation, an almost constant irrigation of 
the wound was kept up with a Bichloride of Mercury solution 
1-2000, the sponges being used but very little. 

Three holes were drilled in each fragment. These began from 
i to $ of an inch back from the sawn edge and ran obliquely down 
to, but not through the articular cartilage. The wires were then 
passed through the corresponding holes in the two fragments, 
and with a strong pair of toothed forceps the fragments were 
brought into apposition. This was much more difficult than would 
be supposed, as the quadriceps having become somewhat contracted 
owing to the lengthening of the tendon, had now to be practically 
overstretched. Another difficulty was found in bringing the sawn 
surfaces into exact apposition on account of an obstinate tendency to 
tilt. However, this was accomplished, the wires were twisted as 
tightly as they would bear, and the ends cut off short and tucked 
down along the line of union, and covered over by the periosteum. 
The wire was of pure silver and in the second operation as thick as 
an ordinary probe. Two rubber drainage tubes were placed at the 
angles of the wound, and the flaps brought down and fastened by 
three button sutures and the edges more closely approximated with 

Bureau of Subgeby. lit 

catgut, sutures. Iodoform was then dredged on thickly, covering 
the incision and the ends of the tubes. The dressing of borated cot- 
ton in layers of corrosive sublimate gauze was then applied, and 
over this a sheet of the rubber tissue which had been soaking in the 
solution, and the whole held in place by a roller bandage. Then a 
plaster of Paris bandage was applied from just above the malleoli to 
well up on the thigh, leaving an open space over the wound for inspec- 
tion. Before application the rollers containing the plaster of Paris 
were wet in the Bichloride solution instead of plain water. After 
this had set, the patient was put to bed. 

For the first day or so after each operation, there was a little serous 
oozing which passed through the plaster on the under surface, and I 
directed the nurse to daub on more plaster wet with the Bichloride 
solution 1-1500, several times a day until the oozing stopped, which 
it soon did. » 

There was nothing after either operation calling for any special 
attention. The highest temperature was 100.5° Fah., which was on 
the day succeeding the first operation. The dressings were not opened 
until the sixteenth day, and then only for removal of the rubber tubes 
and button sutures. No pus was found on the dressings — only dried 
serum. In the first wound, owing to the not exact coaptation of the 
integument, there was a little raised point of superabundant granula- 
tion. This was snipped off and touched with Nitrate of Silver 
once* or twice, and gave no further trouble. Aside from this, both 
wounds healed perfectly by first intention. The plaster of Paris 
splints were retained in position for six or seven weeks, until I was 
certain that union had taken place. 

The patient remained in the hospital until the middle of August, 
when she was discharged cured. She had not then walked on account 
of the nervous fear of refracture. At that time the wounds were 
perfectly healed, both patellae were movable, the cicatrices non-adher- 
ent, and she could flex the legs in the thighs to a few degrees. 

In this paper I have made no attempt at gathering statistics or quot- 
ing opinions ; this has already been done by others, and the operation 
has a recognized standing. 

The points I wish especially to draw attention to are : 1st, the fact 
of the existence of the two layers of ligamentous connection between 
the fragments, as shown by Dr. Van der Meulen ; and 2d, the good 
result of a thorough application of the antiseptic method. Although 
the joint was opened in the first operation, no trouble followed, and 
I challenge anyone to open the knee joint without antiseptic precau- 


I 5 ** 

A' . 

ft* 1 




118 Bureau of Surgery. 

v tions, and not have it followed by either pus formation or a decided 
rise of temperature. Indeed, as was significantly pointed out by Dr. 
F. C. Fuller, in an article on the subject, the men who favored this 
i * as a primary operation were those practicing the antiseptic method, 

while those who opposed the operation and considered it dangerous, 
were opponents to antisepsis. 


By Prof. H. F. Biggar, M. D., 


Mrs. Salter, aged 28, the wife of a coal miner living at Salineville, 
O., four feet in height, usual weight sixty-five pounds ; a patient of 
Dr. J. A. Sapp of the same place. This is her fourth impregnation, 
the former three going to full term and each in succession being 
destroyed in utero. It was the wish of the parents to have^a living 
child, so a few days previous to this last confinement she was sent to 
Huron Street Hospital. 

Labor began in the morning of December 16. Her case was care- 
fully watched by Prof. J. C. Sanders, Drs. J. A. and L. W. Sapp and 
Myra K. Merrick. Before completion of first stage of labor, in con- 
sultation with the above doctors, it was decided to perform the 
Caesarian section, the deformity of the pelvis warranting such an 
operation. At 9 o'clock in the evening of the same day,with the assist- 
ance of the above and Drs. A. K. Smith and J. Kent Sanders, the 
operation was performed. 

An incision, extending from the umbilicus to a line above the 
symphisis pubis, was made down to the uterus, which was then 
firmly fixed. An incision in the uterus was made six inches in 
length, and the child quickly removed with the afterbirth, the uterus 
being grasped to assist contraction. Eight deep sutures of catgut 
and eight superficial completed the uterine operation. No fluid was 
allowed to get into the abdomen, which was closed with silk sutures, 
and a drainage tube inserted through the neck of the womb into the 
vagina. No unpleasant symptoms arose during convalescence. 

The treatment locally used was Calendula and Glycerine in the pro- 
portion of one to eight, the main remedy being Arsenicum. 

The mother and child returned home within a month after the 
operation, and up to the present are well. 

Bureau of Surgery. 119 


(radical cure of hernia.) 

Dr. Van Denburg : I would like to ask whether it is definitely 
known that the mesentery was shortened by Lycopodium ? 

Dr. Lee : I will say that Prof. Gilchrist, who wrote the article on 
hernia for Arndt's System of Medicine, states clearly there that Lye. is 
used on clinical indications. It is a remedy that has been spoken of 
by a number of our writers as being a good agent for hernia where 
there is gaseous distension. 

Dr. Boocock : Dr. Thompson, of England, experimented on Lyco- 
podium some time ago as to how we obtained its medicinal property. 
He states that there is no benefit obtained until after the 6 dec. The 
powder, when seen under the microscope, is a fine nut, and it is broken 
only as he gets to the 3rd and 6 dec. He gets the medicinal property 
by transmitting the sugar through ether, and so he gets an oily matter 
which is the medicinal property. We don't get Lycopodium below 
the 6 dec, but above it we do. Those of us who have tried it know 
we get no result of Lycopodium below the 6 dec. I use it very fre- 
quently for the extended gaseous condition of the abdomen and 
always receive prompt results. I recently had a case — crural hernia with 
peritonitis — which passed through my hands, which has been cured by 
medicine without surgery. The man was on his back for two 
weeks and I never saw a case of greater inflammation ; peritonitis was 
supreme, and the pain caused by the inflatfon of the bowels by the gas 
was very great. It was removed by Lycopodium 6th. The man is up 
now and apparently well. 

Dr. Van Denburg : I do not see that it is anything more than an 
inference. I understand it to be stated as a fact. I do not think the 
proofs are sufficient to warrant such statement. Nothing short of a 
port- mortem could prove that, and even this might leave a doubt. Let 
us be as exact as possible and not claim more than the premises admit. 
These loose inferences are those that deteriorate our observations. We 
may grant that the hernia disappeared, but not assign the cause as more 
than inferential until more conclusive proof. 

Dr. Wiloox : I have operated twice in the cases of hernia, where 
1 just stitched through the sac at the neck, with large sized catgut and 
then stitched this to the walls or sides of the ring by means of silver 


Bureau of Surgery. 

sutures, so that it was all fastened together and then the sac was cut off 
close to the portion where I stitched the membranes together. The 
after treatment differed a little from Dr. Gilchrist's, because I used a 
different dressing, and in such a manner that I could leave my dressings 
in place for a week. 

Dr. Lee : This is the paper of Prof. Gilchrist and not my own. I 
give it as his opinion, and he states, in the last clause of his paper : 
" There can be no doubt that the shortening of the mesentery is caused 
by giving Lye." 

(wiring the patella). 

Dr. Boooook : I would like to ask the doctor whether he used any 
internal medication ? 

Dr. Wilcox : I employed a little medication and only to remove 
the pain. I think after the second operation, where the fragments 
were further apart than in the first, on account of the extreme tension 
on quadriceps muscle, a small hypodermic of Morphine was given. 
No other medicine was necessary. 

Dr. Boooock : The object of my asking was to find whether the 
bones were needed to be united quickly. I have , had two or three 
cases which united very promptly under the influence of Calc. phos. 
so you could feel the deposit of the lime round the broken part 
from the outside, and the bone united so quickly that it is worthy 
of note. 

Some years ago I had a case come into my hands out of the hands 
of Dr. Megs. A fracture of the fibula, which, after six months, was 
still without union. The woman could go about on crutches, carrying 
her leg in a sling, but could not under any cirenmstances bear to touch 
the ground with it. In this condition I found her, the leg very much 
swollen, the crepitation of the bone could be heard distinctly. I gave 
her Calc. phos. 6th dec. three times dailyand told her to eat plenty of 
cabbage and any kind of vegetables. In three weeks she could step 
with the lame foot. 

Dr. von Grauvogl tells of an aged officer in the Prussian army, 
whose broken leg had been stretched until he had one additional joint 
in it but no power to walk. He was entirely restored, the additional 
joint hardened under Calc. phos. and the fracture was cured. From 
the end of the broken bone exudes a fluid, which in time will harden. 
Calc. phos. quickens this hardening process and so shortens the time of 
the cure. 


Bureau of Surgery. 121 

Dr. Lee : It is well known that I take no stock in antiseptics. 
New York is a dirty place, and it may be needful to use them here, 
but not in a cleanly little town like Rochester. 

Dr. Wilcox : I am a thorough believer in antiseptics, as I said 
before, and so strong is my belief that I feel absolutely afraid to do 
any operation of magnitude without it. If I opened a knee joint and 
anything happened ; if I had suppuration, or the patient had pyaemia, 
as in a case reported in the Medical Record some time ago, if such a 
result should happen and I had not employed the strictest antiseptic 
methods I should feel criminally responsible. The importance of 
antiseptics is recognized by the governments of Europe, where anti- 
septic practice is enforced; it is recognized in the courts, where a 
surgeon not treating a wound with an antiseptic has been considered 
guilty of malpractice. In my own experience, (though perhaps not as 
extensive as that of Dr. Lee), I have seen and treated a good many 
wounds where we used to be as careful and cleanly as anyone could 
be without especial antiseptics. Take, for instance, an amputation of the 
breast, the wound was dressed twice a day, but the pus ran out and the 
odor filled the room, and the patient always had a high fever, careful 
as one might be. Now I don't ordinarily dress a wound under two 
weeks, and 1 don't think I am less cleanly. There is something in the 
method ; it stops the suppurative process ; it prevents the patient hav- 
ing the high fever he used to have, and enables us to do with impunity 
now what we did not dare to do years ago. 

Dr. Lee : Dr. "Wilcox defies any one to open the knee-joint and 
have the wound heal without suppuration where antiseptics are not 
used. I have opened the knee-joint three times during the last two 
years and plain dressings were employed in all of the cases. The 
wounds healed with no suppuration except in one case. This was a 
gun-shot wound. The bullet passed into the joint just below the inner 
border of the patella, and was embedded deep between the cartilages. 
A rather long incision had to be made to extract the missile. This was 
attended by suppuration and high rise of temperature, from which he 
recovered in three or four weeks with a perfect leg. 

Gentlemen, I do not believe that we know much about germs ; cer- 
tainly we do not know, at the present, that they are the cause of disease; 
quite the contrary, they are probably the result of disease ; God's scav- 
engers and nothing worse. 

I believe with those great German surgeons who were led to exclaim 
in one of their conventions across the water, when Keith made his 

122 Bubeau of Surgery. x 

report of wonderful success without antiseptics : " Mine Gott, Lister- 
ism ist todt! Fort mit dein spray." I believe that Listerisra is dead; 
that all the good antiseptic practice has accomplished is to teach the 
profession that the details earlier considered of little consequence, like 
perfect cleanliness, drainage of wounds, the use of absorbable ligatures, 
and an hundred other little points, are of paramount importance. It is 
the observance of these little things, with increased skill in operating, 
which has brought surgery to its almost wonderful state of perfection, 
and not these poisons. 

Dr. H. I. Ostrom : I cannot agree with Dr. Lee in his denouncia- 
tion of antiseptics in abdominal surgery. I use strict antiseptic meth- 
ods in all my abdominal sections, and I have yet to meet with my first 
case of poisoning from such practice. I have used very hot water to 
flush the abdominal cavity only once. It was a case of shock, during 
an unusually difficult ovariotomy. I filled the abdomen with hot 
water, and I think by so doing assisted to overcome the extreme 
depression, which developed without the common indications of danger. 

Dr. Boocock : Very often, in our whole treatment of these injuries, 
wounds, etc., in private practice and at the bedside, we have no 
chance for antiseptics ; and in surgery wards in the hospital it seems 
almost impossible to do without them. 

(the before and after treatment of laparotomy.) 

Dr. Lee : I did not notice the mention of the usefulness of hot 
water in profound shock and to check hemorrhage resulting from 
separation of adhesions. The operator will occasionally run across a 
case that will result in shock, and for a time it may seem that the 
patient will die. The best remedy is to fill the abdomen full of water 
at a temperature of about 110° ; then use your other helps with it. 

These antiseptic fellows are anxious to " do me up ;" they are here 
in force, and should be allowed to air their germs a little. 

Dr. Wilcox : I have never vet seen a case of Corrosive sublimate 
poison, and have used it without stint. I use Iodoform on granulat- 
ing wounds, and have never had the slightest bad result afterwards. I 
have never seen the slightest deleterious result from the use of Carbolic 
acid. I don't believe in using Corrosive sublimate solutions too strong, 
one to five hundred, as surgeons did use it at first .There seems to 
be a certain condition in which patients are especially susceptible to 
the action of Corrosive sublimate solution, and that is after confinement, 
where irrigations have been used containing Corrosive sublimate, 
and where they seem to be especially susceptible to its poisonous influ- 

Bureau of Subgeby. 123 

ence, and a few bad results have been given ; but otherwise, I have 
never heard anything bad with the solution in the strength ordinarily 
used. In the cases where poisoning has been reported, very strong 
solutions were used. 

Db. Lee : The doctor is wonderfully ignorant on the subject. I 
am surprised that a gentlemen of his learning should not know that 
the back files of many of the journals published in Europe and Amer- 
ica are teeming with reports of deaths from the use of the various 
agents to destroy germs. The Mercuric bichloride unites with the albu- 
men of the tissues and forms an albuminate of mercury and is per- 
fectly inert. It is not until this agent is used in the proportion of one 
to four hundred that it will destroy the bacteria and then it does the 
work by killing the patient as well. 

Db. S. H. Knioht : I never did an abdominal section myself, but 
during the last two years have assisted several different surgeons in 
this city in some forty cases, and after the operations have had 
charge of the treatment. So I am somewhat familiar with the methods 
pursued and the complications that may arise. These cases include 
various operations, from a simple exploratory incision to double ovarioto- 
mies and hysterectomies. In all these cases jether was the anaesthetic. 
I believe in giving patients as little ether as possible. Simply keep 
them quiet, and even allow them to partially recover consciousness once 
or twice. I have never seen any bad effects from the ether. Twenty 
minutes before giving the ether give a hypodermic of Morph. sulph. 
£ gr. and AtropifiB sulph. yfoj- gr. 

For the first twelve or twenty-four hours nothing but ice or rice-water 
is allowed the patient in the way of nourishment. After that milk, 
diluted one-half or one-third, may be given in small quantities at fre- 
qnent intervals. No animal food is allowed before the seventh day. 
Any attempt to substitute this for milk diet too early has always been 
regretted. Gradually from this the patient receives a full diet. 

In the treatment of abdominal flatulence I find Lycopod. the best 
remedy. Its action is sometimes really wonderful. I remember one 
case, a hysterectomy, in which there occurred a stoppage of the bowels, 
causing matters to look very serious. Lycop. was the only remedy 
used, and in forty-eight hours gas passed freely and there was no 
further trouble. 

If patients crave tea, even on first day, I allow them to have it. I 
have seen it relieve vomiting which had persisted for days and resisted 
all remedies. 


we need not bother about the bowels for seven or eight 
rive them at night an enema of oil, another in the morning, 
it up in three or four hours with one of warm water. After 
Belladonna, or some indicated remedy will generally suffice, 
eparation of Malt with Cascara is very good. 
lilting, I think it the hardest symptom to combat. , It 
think, partly on the individuality of the patient and partly 
everity of the operation, together with the anEesthetic 
ends upon the ligatures used in the operation hardly seems 
or I have seen cases where there were many adhesions 
igation, and again cases of supra-pubic hysterectomy where 
rubber ligature wound tightly about the uterns itself, with 
vomiting. In those cases where the rubber ligature was 
removal of a fibroid tumor, though there might be a pro- 
phage from the tumor itself, yet not a drop of blood escaped 
idicle. Veratrum alb. and Arsenicum are the best reme- 
ttinate vomiting. 

, on the whole, the wire stitch is the best. It gives some 
removed but they can be quickly iutroduced (and time is 

through skin, muscle and peritoneum and then easily 

operations are done antiseptically. For sponges, flannels, 
> into the abdominal cavity we use the Bi-chloride mercury 
35000. In a few cases we have tried pnre water and had no 

eliever in antiseptics. 

Antiseptics are stylish ; there are styles in millinery, 
jss of every kind, and styles in surgery, which are the most 
f all. Gentlemen, I feel that the law should hold me culpa- 
lould employ Mercury, Carbolic acid, or any other poison 
i patient a victim of their toxic influence. And I claim 
of death any court ought to hold a surgeon accountable 
oduction of such rank poisons, into clean wounds. 




A. B. Norton, M. D., Chairman^ - - - New York City. 

Drs. Wm. P. Fowler, Rochester. 

John L. Moffat, Brooklyn. 

N. L. McBbide, New York City. 

Chas. C. Boyle, New York City. 

Disputants : Drs. Geo. S. Norton, - - New York City. 

F. H. Boynton, - New York City. 


By Charles Deady, M. D., 


To a large majority of the general public, the fitting of spectacles 
is an exceedingly simple matter, it being only necessary to look over the 
stock of some vender of the article, (often a traveling peddler) and 
select what seems to be about the thing ; the whole business being 
transacted in much the same fashion as would be the case in the pur- 
chase of a barrel of flour or a cord of wood. It is unnecessary to 
inform the intelligent physician that this is all wrong, but few realize, 
even in the medical profession, what a momentous matter the choice 
of spectacles may be under certain conditions. 

At the present time, in our large cities, much of this business is in 
the hands of reliable opticians, who have a fair knowledge of what is 
required in ordinary cases, and many of whom are sufficiently consci- 
entious to refer the patient to an oculist when they are in any doubt. 



ifcf. v . 

► ■ V ' 





126 Bureau of Ophthalmology. 

Even under these, the most favorable conditions, the experiment is 
often ill-advised, as of course no optician takes into consideration pos- 
sible irritability or spasm of the ciliary muscle, the disturbance of 
equilibrium in the action of the recti muscles, or the not infrequent 
, intraocular complications, only to be discovered by an examination with 
the ophthalmoscope. 

If we deprecate the fitting of glasses by the educated optician, who 
at least understands the optical necessities, what must be thought of 
the village jeweler and the itinerant " professor " who are in many 
cases too ignorant to ascertain the number of a glass, except by its label 
(which is generally wrong) and who sell to a confiding public their 
" diamond pebble," " opal tinted," " medicated " spectacles at the low 
price of $9.00 per pair — cost thirty-four cents each by the gross. 

The injury which may result from the interference of these med- 
dlers becomes, in a certain class of cases, so great as to almost war- 
want us in charging them with criminal ignorance. Who among ocu- 
lists has not seen cases of progressive myopia which have been 
" fitted " with glasses in this manner until the patient was almost blind ? 
How many patients with intraocular disease are despoiled of precious 
time by delaying their visit to a competent physician until they have 
tried the various glasses offered for sale in their neighborhood ? 

In purchasing glasses haphazard the patient becomes his own judge 
as to the fitness of the selection, and as a matter of fact his judgment 
is a very poor one to rely upon. The correct rule in prescribing glasses 
for myopia, or near sight, is that the weakest glass which enables the 
patient to see distinctly should be given. Now An practice we find that 
the patient, if left to himself, will almost invariably choose too strong 
a glass, because he gets a brighter picture with it. Again — unless my- 
opia is high in degree, the patient is usually aj)le to read without any 
glass, and prefers to do so. Nevertheless it is often necessary to give 
such patients not only a glass for distance, but another for reading — 
not to make reading easier, but to make them hold the book farther off 
and thus prevent undue convergence. 

In hyperopia, or far sight, the rule is to give the strongest glass, 
which, while fulfilling certain conditions, can be worn with comfort. 
In a large number of cases patients purchase instead the weakest glass 
they can get along with, on the old theory that by delaying the use of 
glasses as long as possible and by using the weakest number that will 
accomplish the work, the preservation of sight is guaranteed for the 
longest period. 

^^Ila l 


Bureau of Ophthalmology. 127 

In cases of spasm of the accommodation, we often have apparent myopia 
with actual hyperopia. No examination, as practiced by even the best 
optician, will reveal this state of affairs, as it cannot be detected without 
a careful examination with the ophthalmascope unless Atropine be used. 
If such a patient choose his own glasses he will naturally select a con- 
cave lens, whereas his condition of refraction requires a convex one. 
The writer has recently treated precisely such a case, in which a hyper- 
opic patient with spasm endured a concave glass of considerable 
strength for over a year, at the expense of much discomfort. 

Where spasm complicates myopia, the latter is apparently increased, 
and the patient requires a stronger concave lens to see distinctly than 
the myopia alone would call for ; if he obtain it the difficulty becomes 
the more obstinate, and the actual myopia often becomes progressive. 
These are the cases where spectacles are like edged tools, to be handled 
safely only by educated skill. 

In cases of astigmatism, the refraction in one principal meridian of 
the eye differing from that in the other, the oculist is usually consulted 
after a series of unsatisfactory experiments with all kinds of glasses* 
each of which seemed to be the thing for a short time. 

The question as to whether spectacles or eye glasses should be worn 
is frequently asked by patients. The answer must depend on the charac- 
ter of the case. In many cases the shape of the nose renders it 
exceedingly difficult to retain the eye-glass in position ; often where the 
physical conformation is all that could be desired, the pressure of the 
spring causes a disagreeable drawing sensation in the eyes, which not 
only causes much discomfort, but in some instances causes reflex ner- 
vous symptoms. These conditions, however, are so troublesome to the 
patient that they generally result in a change to spectacles before any 
harm is done. 

One principal objection to the eye-glass is the fact that its relation 
to the eye is not a constant one, it is a common habit to place the eye 
glass upon the nose at varying distances from the eyes and at almost 
any angle with the face. If the lens be of short focus a considerable 
difference in its power may result from changes in its position. If a 
spherical lens be tilted sufficiently it becomes virtually a cyclindrical 
lens. Astigmatic patients who are not aware of their defect, and are 
wearing spherical glasses, sometimes make use of this fact, as they dis- 
cover by experience, that vision is improved by tilting the glass to a 
certain angle. It is a common and careless habit among others. In 
cases of astigmatisms, where cylindrical lenses are prescribed, their use 
in the form of an eye-glass is often unsatisfactory, because of the dif- 

128 Bueeau of Ophthalmology. 

ferenee in the inclination of the axes of the cylinders in one position 
on the nose as compared with another. And also because the axes may 
in time be permanently changed by weakening or bending of the 

In certain cases, however, we may prefer eye glasses to spectacles. 
Thus in myopia of a high degree, we wish to give our patient glasses 
for such use only as may be actually necessary, fearing an increase of 
the near sight if more be allowed. If we give such a patient specta- 
cles the chances are that he will not take the trouble of removing 
them. In cases of hyperopia or presbyopia where glasses are only 
used for near visiou, the eye-glass is often preferable for the same 
reason, especially among busy men whose occupations require that they 
should use the eyes for near vision frequently for short periods. 

Having decided that spectacles are necessary, there are several points 
to be carefully attended to, for it is quite possible for a lens of the 
proper strength to be so adjusted to the face that its use will be very 
unsatisfactory and even painful. 

The spectacle frame should not be too light. In the effort to reduce 
weight the opposite extreme is often reached and the thinest kind of 
wire is used. These glasses should be avoided, as they have not suffi- 
cient strength to retain the original shape, and are apt to lose their 
parallel relation to each other and to deviate from a correct centering. 
The so-called " skeleton " glass without frame is often injurious, because 
of the prismatic action of the edge of the lens, producing sometimes 
a play of colors which is dazzling to weak eyes. 

The lenses should be far enough from the face to clear the eyelashes 
easily and no more. This is a very important matter in a strong concave 
glass, less so in convex lenses. If the glasses are intended for reading, 
they should tilt forward slightly, the plane of the glass in reading 
should be the same as the plane of the printed page. 

The center of the lenses should correspond with the position of the 
pupils ; if a pair of convex lenses are set too far apart, the pupils 
strike the glass to the inner side of its center and we get the effect of 
looking through a pair of prisms with their bases outward, which is to 
turn the eyes inward to an excessive degree, producing pain and mus- 
cular weakness. It is especially necessary that the centers of the 
lenses be of equal height, as the power of the superior and inferior 
recti muscles is very slight as compared with the internal and external, 
and a deviation in this direction may produce great discomfort, with- 
out being very considerable in degree. 

Bureau of Ophthalmology. 129 

Where glasses are intended for near vision their centers should be 
nearer the median line than for distance, as the eyes naturally con- 
verge in looking at near objects. When correct lenses are prescribed 
and all other requirements are satisfied, the result is usually all that 
can be desired, while the failure to meet many of these conditions, in 
glasses manufactured by the gross, is the cause of mnch visual weak- 
ness and suffering. 



By Chas. C. Boyle, M. D., 


Dr. Norton in his Ophthalmic Therapeutics says that " its action 
npon the uveal tract is very marked, especially in the serous form of 
inflammation." In this paper I wish to report the history of two cases 
of disease of the eye involving the uveal tract that had been under 
treatment by the old school oculists and pronounced incurable. These 
cases were both treated and cured by the administration of Gelsemium 
internally. One was a case of detachment of the retina in an eye con- 
siderably myopic, and probably brought on by excessive use of the 
eyes, myopia being one of the causes that tend to detachment of 
the return. This patient had been under one of the best oculists in this 
city, and was treated in his private hospital for over a month, being not 
only confined to bed during that time with the eye bandaged but 
besides had had paracentesis made through the choroid at the back 
part of the eye to draw off the fluid between the retina and choroid. 

All of these means failed and the man was finally discharged and 
pronounced incurable. He then came to the New York Ophthalmic 
Hospital to Dr. Geo. S. Norton's clinic, whose assistant I was at that 
time. Dr. Norton being away, I advised the patient to come into the 
hospital and stay for a month and see if he could be benefited. I 
did not give him much encouragement, as the case had already 
had good treatment, with the exception that Gelsemium had not 
been given. This I explained to him, and told him I had seen 
a case similar to his cured, but it had not been of so long stand- 

130 Bubbau of Ophthalmology. 

ing. He was willing to try and came into the hospital. The eye was 
bandaged and the patient put to bed and kept on his back most of the 
time. At the end of six weeks he was discharged cured with a vision 
of $$, the loss of present vision being due to a slight posterior polar 
cataract in both eyes, which he had had for some time. Afterwards 
he had the pleasure of going back to his old-school friends and show- 
ing them what we had done for him. 

The other case is also one which Gelsemium cured after theold school 
oculist had pronounced it incurable. A man sixty-five years old was sent 
to me to be examined for his eyes by a society who were to pay him 
some money on account of total blindness in one eye and partial in the 
other. One eye had total detachment of the retina from an injury, 
with entire loss of vision, and the other eye with a vision of $$ ; on 
examining this eye with ophthalmoscope found vitreous cloudy and 
filled with opacities. I gave a certificate to that effect and pronounced 
him incurable, but before he left the office I questioned him in regard 
to his treatment, and judged from his answers that it had been princi- 
pally Iodide of Potash, which by the way is a very good remedy in 
opacity of the vitreous. I then gave him a prescription for Tinct. 
Gelsemium and told him to take three drops four times a day, but told 
him I did not believe it would help him, but he might try it. I never 
expected to see him again, but what was my surprise when he came to 
my office, some three months after, asking me to fit his eye to a glass. 
I told him no glass would help him, but however I would try, and 
found his vision J# without glasses, and with a +0.75 D it was |f — 
perfect vision. On examination with ophthalmoscope found vitreous 
entirely cleared up. 

As he had already received his money for blindness, I told him he 
had better nQt say much about his restored sight. He said he had no 
one to blame for it but me. 

These cases will illustrate the advantage we have over our old school 
friends in the treatment of diseases of the eye, not only in the troubles 
spoken of above, but in all that the eye is subjected to, and at the 
6ame time we employ the means which they depend on, such as rest, 
bandaging, operations, or the use of Atropine when necessary to keep 
pupils dilated to prevent adhesions. 

Bureau of Ophthalmology. 131 



By E. H. Linnell, M. D., 


Case I. Colocynth in Irido-choroiditis* 

On the 5th of Jan., 1887, 1 was called to see Mrs. W., in consulta- 
tation with Dr. B. I found her suffering with Irido-choroiditis serosa 
of the left eye. She had been sick five weeks. The condition of the 
eye, at the time of my visit, was as follows : Iris discolored and pupil 
contracted. Slight pericorneal injection, especially in lower portion of 
eye-ball. Slight cutting pains. Eye very sensitive to touch or 
motion. T +1, vitreous filled with fine opacities preventing a view 
of the fundus with the ophthalmoscope. Vision reduced to counting 
fingers at 3 ft. I advised the use of a 1 per cent, solution of Atropine 
sufficiently often to keep the pupil well dilated, and the use of Bry- 
onia internally and the case was left in the hands of the family physi- 

One week later I again saw the case in consultation. The pupil 
was then dilated ad max above, but not quite as much below, and the 
iris was still of a greenish hue, instead of the natural blue of the other 
eye. The subjective symptoms were entirely relieved, but the condi- 
tion of the fundus and the vision were unchanged, and the tension 
was still a little increased. Iod. potass. l x was advised, together with 
the instillation of Atropine 1 gr. to oz., n and m. 

At my next visit, one week later, the iris was of normal color and 
luster and there was no epi-scleral injection. The vitreous was less 
cloudy, so that the optic disc and the retinal vessels could be dimly 
made out, and there was a corresponding improvement of vision. The 
same treatment was continued. 

One week later there was still further improvement in the appear- 
ance of the fundus and of the vision, although there was again some 
sensitiveness of the eye, which I attributed to an unfavorable change 
in the weather. The same treatment was continued with the addition 
of a single dose of Sulp. 80 every second day. 

Two days later there was a severe aggravation of the disease, and the 
case was placed in my hands. Without apparent cause, there was 
renewed iritis with severe pain and tenderness, increased cloudiness of 


132 Bubeau op Ophthalmologt. 

vitreous, and obscuration of vision. In fact the condition was as bad, 
if not worse, than at any time previously. I was at a loss to account 
for this sudden relapse, as the patient's general health was good, and 
she had not, to my knowledge, been imprudent in any way. The 
mystery was solved a few days later when she confessed to having 
used a solution of Colocynth, (or bitter apple), in rum as a hair wash 
just previous to the aggravation of the eye trouble. She had been in 
the habit of using it frequently for a year or more, and I learned that 
she had been subject to frequent attacks of colic which presented the 
well known characteristics of Colocynth, and were controlled by that 
remedy. I will not weary you with a further detailed report of the 
case. Suffice it to say the hair wash was not used again and she made 
a complete recovery in a reasonable time, and with no other remedies 
than those previously used. Bryonia gave relief in the acute stage, 
and Iod. potass, and later Sulph. cleared up the opacity of the vitreous 
and restored normal vision. 

I think we may fairly consider this case as aggravated, if not pri- 
marily caused, by Colocynth. The drug is readily absorbed through 
the skin, producing its specific effect upon the alimentary canal just as 
when it is taken by the mouth. In the accounts of poisoning by this 
drug we find that it produced obscuration of vision in one person, 
and others report twitching of the upper lid of the right eye, and pain- 
fulness of the eyes, increased by stooping. In the pathogenesis of the 
drug we have developed the cutting and burning pains in the eye, and 
the tearing and boring pains in the temple and side of the head, and in 
the face. Dr. Watzke, of Vienna, who made a thorough proving of 
the drug says : " The hemi-crani® and perso-palgiae which Colocynth 
will cure are in all cases purely functional derangements of the tri- 
facial nerve." Does experience bear out the truth of this statement ? 

If my assumption is correct, that Colocynth caused in the case nar- 
rated actual inflammation of the iris and choroid, it should be cura- 
tive in similar inflammatory conditions, if there is any truth in our 
therapeutic tenets. The following case is the only one that I can find 
recorded where an organic affection of the eyes was cured by Colo- 
cynth. The case is so imperfectly recorded as to leave us quite in the 
dark as to the real nature of the disease, but it evidently was some- 
thing more than trigeminal neuralgia. 

" The patient had been afflicted for a considerable time with an 
almost permanently existing headache, after which the eye became 
inflamed. When Dr. S. was called the patient had already lost his sight. 
In the right eye, the sight of which was still p*eserved, the patient 

Bubeau of Ophthalmology. 133 

complained of burning, cutting pains. Congestion of blood to th,e 
head and discharge of acrid tears from both eyes troubled the patieut. 
Two drops of the tincture of Colocynth every three hours removed the 
headache in twenty-four hours and effected a considerable abatement 
of the pains in the eyes. The continued use of Colocynth restored 
the sight of both eyes completely in eight days, and effected a perfect 

The pulp and seeds of the bitter apple contain a large amount of 
mucilaginous matter which I suppose is the quality that recommends 
it as a hair wash. I did not know that it was ever used for such a pur- 
pose until Mrs. W. spoke of so using it, but I have since found it in 
another family where I have frequently been called of late to prescribe 
for attacks of colic. I do not know how commonly it is used in this 
way, but I think we should do well to warn our patients of its poison- 
ous properties as opportunity occurs. 

Case II. Traumatic rupture of Iris and permanent Mydriasis, 
without external wound. 

Nov. 8th, 1886, Harry P was struck in the right eye with a 

stone four days previously. The lids were closed for three days. Now 
there is no external sign of injury either to lids or ball, but the pupil 
is dilated nearly ad max. and there is a small rent in the pupillary bor- 
der of the iris at the temporal side. T. — 1, no pain ; vision either 
eye £# ; that of left made J$ + with — ^ , but glasses do not improve 
vision of injured eye. The opthalmo&cope shows a little hyperemia 
of the retina but no lesion is discoverable at the bottom of the eye-ball. 
Prescribed Arnica internally and a solution of Atropine 1 gr. to the oz., 
to be instilled night and morning to still further dilate the pupil, and 
prevent if possible the formation of adhesions between the torn edges 
of the iris and the anterior surface of the lens. 

Nov. 15th. Vision increased to {$. Retinal veins a little swollen 
and retina in vicinity of disc a little hazy. Discontinue Atropine, con- 
tinue Arnica. 

Nov. 27th. Vision perfect. Outlines of disc now for the first time 
clearly defined, though there still remains a little retinal hyperemia. 
Iris dilated ad max. in vicinity of coloboma, not so much so on inner 
side. No reaction to light. Slight crescent at the inner edge of disc, 
and choroid pale around it for a distance of one disc diameter. $ 
Eserine, 1 per cent, solution three times a day. 

Dec. 28th. Has been using Eserine since last date. It contracts 
the pupil temporarily but the effect passes off in about two hours, 
when the pupil becomes as large and immovable as before. Discon- 
tinue Eserine, and take Duboisin 3 X once in three hours. 

Bbkeau of Ophthalmology. 

22d, 1887. At this date the condition remains as previously, 
lat two email synechias have formed at the edges of the c*h> 
Sight is perfect. 

sase interested me because of its uniqueness. I do not 
;r to have read of a similar case of traumatic rupture of the 
out an external wound. I at first considered the above 
id crescent at the edge of the optic disc as a ^poBtstaphy- 
t subsequent examinations proved the eve to be entirely 
pic, and I concluded that it was a choroidal coloboma pro- 
r the injury. Did I treat the case judiciously ? Would the 
.11 the iris have been more likely to heal if I had used 
it first, instead of Atropine ? Adhesions would most likely 
med, but these might have been broken up by a subsequent 

III. Hdonias Dioica in. inflammation of the optic nerve. 
nothing in the pathogenesis of Helonias to suggest its applica- 
any ocular affection, nor is there any reference to it in Nor- 
iphthalmic Therapeutics." In the following case the im- 
nt following its administration was prompt, decided and 
nt. It ib, therefore, in the hope of adding another drug to 
of those useful in the affections of the optic nerve and retina, 
tcially when associated with renal disease, that this case is 

! , 62 years old, consulted me first Aug. 9th, 1886. He 

he formerly had had keen sight, but that it had been gradu- 
ng for the past six months. It was then only ^ with either 
ie field of vision was not accurately tested but it was markedly 
id, for with strongly magnifying glasses he could only see 
i of a printed word at once. The peripheral field was, how- 
fc entirely wanting, as he noticed the movement of my hand 
rections. With the ophthalmoscope the optic disc in each 
lost its transparency and presented a blurred, hazy appear- 
th indistinct outlines. The retinal veins were somewhat 
and the arteries upon the disc were small and somewhat 
y an apparently serous infiltration. The fundus in other 
presented a natural appearance. The gentleman was ana>mic 
le, and his eyelids were cedematous. An examination of the 
re the following results : Quantity in 24 hours 5 gills, turbid 
acid and sp. gr. 1018, and containing a trace of albumen. 
ie microscope numerous pus corpuscles, a few epithelia from 
les of the kidney, and some fatty and granular casts were 


Bureau of Ophthalmology. 135 

seeu. Under treatment his general health improved, and with it the 
vision, until the record, Oct. 16th, was : v. o. u. as before — ^{j-, but 
+ 16 makes it $$. The urine increased in amount and became less 
turbid and the albumen disappeared, but there was no material change 
in the microscopical ppearance. The next record was Oct. 23d. 
Vision j^$ but only w with glasses. This was the only time that 
vision without glasses was more than ^fc, and there was no further 
improvement with glasses. Nov. 22d the condition was as follows : 
Vision as it has been for the past 5 weeks, viz., ^^ without glasses, 
and with + 16. The retinal veins somewhat swollen and a faint 
cloudiness of the disc and of the retina immediately snrrounding it. 
Outlines of disc better defined and less veiling of the arteries. He 
had gained nearly 20 pounds in weight since he first consulted ine ; 
had a better color, but was still weak, though able to walk a mile and 
a half to my office, as he had done all the while. He complained of 
a constant dull pain in the lumbar region, extending around the hips 
and down the legs, and also of a sensation as if the forehead was 
encircled by a tight band. These symptoms suggested Helonias, which 
I prescribed in the l x , 2 drops four times daily. It was followed by 
surprising improvement in vision. In one week the vision rose to $$ 
without glasses, and £# with + 16. In one month it was £# without, 
and {% with glasses, and he was able to read 0.6 of Snellen's test types 
with some hestitancy. Previously he had not been able to read even 
large type. Helonias was continued uninterruptedly until Feb. 9th, 
1887, with the exception of ten days in January, when Rhus was given 
for constitutional symptoms. At this date, Feb. 9th, vision was $$ 
without glasses and {% with +16, and it has continued perfect until 
the present time. He is able to read the finest print without discom- 
fort 7 or 8 hours a day, although his general health gradually fails and 
the urine contains pus cells in increasing quantities. During much 
of the time while taking Helonias he also took Bovonine after meals, 
but no other medicine, so that I think the improvement in vision may 
fairly be ascribed to the Helonias. The last time that I examined his 
eyes the fundus appeared absolutely normal in every respect, aside 
from a slight pallor of the disc. One peculiar feature of the case 
was that he always maintained that he could see very much better in 
the twilight. I found this symptom under China, Ferrum, Hellebore 
and Phosphorus, but notie of these remedies, given in the early history 
of the case, relieved the symptom. 

136 Bureau of Ophthalmology. 


By John L. Moffat, M. D., 


In April, 1885, Mr. E. A. D., aged 48, a spare, stooping business 
man of nervous temperament, complained of confusion and uncertainty 
in distant vision, with vertical diplopia and slight photophobia. On 
inspection there was no marked malposition of either eye, but tests 
revealed myopia, presbyopia and muscular asthenopia. 

R.E. V.&M.1.25 D (V. i+). 

L. E. V. A, M. 1 D (V. f+). 

N. V. Sn. 0.5, p. r. 50 cm pp. 27 -» 

with + 0.5 D Sn. 0.5, p. r. 50 cm difficulty. 

M. Eect. Int. dextra 12 p difficulty, 
u (c « gi n# 12° at first, then 10 p , this at a distance without 


A red glass before the left eye showed the diplopia to be homony- 
mous ; upon looking directly to the left the red image appeared to the 
left and higher — upon looking downward and to the left the displace- 
ment was exaggerated, but both images were still vertical. 

A week later the diplopia was crossed, instead of homonymous, and 
varied during examination, but the patient reported the eyes as being 
stronger. Now the red image (in the right eye) appeared behind the 
other upon looking forward, and also directly to the left, while down- 
ward and to the left it was crossed and tipped inward, showing that 
weakness of the right internal rectus predominated at this time over 
that of the left externus, existing at the first test. 

]jfc. + 0.5 D for near vision, Dyer's exercise and Comum* on pellets, 

every 3 hours. 

Six days later he reported improvement, but examination showed 
momentary homonymous diplopia upon looking directly to the left 

Con.* 00 3 hours. 

Three weeks later he reports the eyes " well some time ago," but 
now is troubled with a dull — sometimes sharp — supra- orbital neuralgia 
of the right side, occasionally extending down into the cheek; better 
when interested in other matters. Worse in stormy weather. Cedron 
l x 3 hours failed but Kalinia,' 9, on pellets apparently afforded relief. 

' \ 

Bubeau of Ophthalmology. 137 

Two years later, in June last, the patient returns with diplopia, which 
has been growing worse for two days, relieved by looking to the left ; 
vision blurs on looking to the right ; he cannot abduct the right eye ; 
homonymous diplopia, paralysis of the right externus. He has been 
reading much ; the eyes feel hot and weak and are sensitive to bright 
light. Gave Con." 6, 2 h., and every two days primary faradism for about 
three minutes from the eye to the occiput. Under this treatment he 
improved slowly — more slowly than in the former attack. The right 
supra-orbital neuralgia recurred, and Gels.* was substituted for the Con. 
and the electricity changed to the interrupted galvanic current, l m * 
for five minutes, positive pole on the insertion of the rectus externus. 

Incidentally, two doses of Gambogia 3d stopped a watery diarrhoea, 
coming with a burst that he had had for two mornings, while upon drop 
doses of Gels.* 2 hours apart. It did not recur, although the Gels, was 
continued three drops three times a day. 

A week later, just a month from the beginning of this attack, he 
complained that with the left eye objects looked smaller, and of vertigo 
upon quickly covering this eye, which, upon being tested alone, everts 
only about three-fourths as far as it should, and upon the binocular test 
it abducts tremblingly three-fifths. There is concomitant (?) conver- 
gent squint, and spasm of the ciliary muscle. 

N. V. E. E., Sn. 0.5, pr. 45°"* p. p. 39 cm 

1. e. blurs and changes. 
+ 2 D brings the near point for Sn. 0.8 to 23 cm for the right and 
22 cm for the left eye. 

5&. d. V. — 1 D N. V. + 1.5 decentered inward. 
Jabor. 1 4 td. 

The minus glasses strained the eyes, and were discontinued and 
Caust. given three times a day, since which time, seven weeks ago, he 
has considered himself cured. 

The above case is deemed of interest enough to report, because the 
asthenopia varied so in the muscles involved, and also as an interesting 
case of pseudo-myopia. It is regretted that the total degree of hypero- 
pia was not ascertained by Atropine or the ophthalmoscope ; probably 
it is quite high as the age, 48, is rather early for such an amount of 
presbyopia. The whole trouble is doubtless attributable to not wearing 
proper glasses several years ago ; as soon as the presbyopia is properly 
corrected all of the symptoms disappear. The trouble recurred because 
the firtot glasses given did not take off the strain upon the accommo- 

JWL^VVj»T , f»TV;'vi:^, t r^» , >*' ' 

t^&itS-i*'-'- *<H*. 

•> ■ i 




138 Bureau of Ophthalmology. 

The minus glasses were ordered for distant vision, because the sight 
was so poor, especially in the left eye, that the desire for binocular 
vision was lessened. The fact that they had to be discarded confirms 
the diagnosis of pseudo myopia. 


Dr. Nobton : There is very little opportunity for discussion in 
clinical cases. The first case of Dr. Linnell's in which Colocynth 
seemed to cause a serous inflammation of the uveal tract is of decided 
interest. Colocynth has been used with benefit in the severe neuralgia 
which accompanies glaucoma, a somewhat similar disease to serous 
irido-choroiditis. It has not, however, so far as I know, ever before 
produced an inflammation of the eye.. In Dr. Linnell's case the drug 
seemed to act upon the secretory tract producing iifbreased secretion 
without resulting in severe pathological changes, as is evidenced by 
perfect restoration of vision. It may, therefore, prove a valuable 
remedy in this class of cases. Heretofore Gelsemium has been the most 
commonly indicated and most generally useful remedy for serous 
inflammation of the uveal tract, while in the plastic variety of inflam- 
mation. Kali iod. 1 has been of more service than any other one 

Dr. VanDenbubg : In regard to the use of Colocynth in inflamma- 
tory states, a case that lately came under observation may be in point. 
It embraced the infra-orbital nerve and its distribution; a nerve 
somewhat intimately connected externally with the ophthalmic 
branches. The muscles of the right side of the face were nearly para- 
lyzed ; the pain was intense in one or two, or occasionally three, sharp, 
terrific stabs. The least touch to wipe the eye or the nose, chewing, 
winking, if not with the utmost care, served to kindle excruciating 
paroxysms. For two years this had been progressing without relief, 
except the temporary respite afforded by Morphine. Cold also 
aggravated; motion of body, other things being equal, did not change 
the attacks. The bridge of the nose was swollen, and two years ago a 
nasal polyp was removed from the " left " side. 

Colocynth 3 X rekindled the pain with extreme fury. Colocynth 


3 m , 5 drops night and morning, afforded great relief. The case has 


been under observation for only about two months. The main point 
to be noted is extreme aggravation from touch, or motion ; relaxed 

Db. Norton : All ophthalmologists agree with Dr. Deady as to the 
importance of careful adjustment of glasses. This is true in regard to 
all errors of refraction, but especially so in myopia and astigmatism, in 
which conditions competent advice should always be taken. The 
selection of glasses by the patient or by an optician who does not 
understand the construction of the eye and its refractive media, 
and only desires to sell the glasses, is particularly reprehensible. It 
leads so often to permanent injury of vision. 

Dr. Deady : I am aware that good authorities advocate the full 
correction of the myopia, and I do not wish to be understood as differ- 
ing from them. Every oculist knows that in examining myopic 
patients the vision is improved progressively as we apply stronger 
lenses until a certain point is reached ; beyond this point no actual 
increase of visual power can be obtained, but we find by experience 
that the patient will generally prefer a glass a number or two stronger ; 
not because he can read any more letters with it, but because it gives 
him a brighter picture. I think that, as a rule, we should give the 
weakest lens which will enable the patient to most nearly approximate 
perfect vision. 

Db. Sayer : When one feels the need of an aid to vision it is most 
important for his future welfare that he finds out whether he 
has any refractive error or not, and hence before putting on glasses 
he should always consult an oculist. 

As an illustration of the wide extent of refractive errors, in a large 
English school of about 1,000 pupils, 703 were found to have some 
form of refractive trouble. 

Foerster and some other of the Germans, I believe, are now advis- 
ing the full correction of myopia by concave lenses as a prevent- 
ive against the increase of myopia, but here, as well as in hyperopia, I 
believe that each case is a case in itself. 

Db. Norton : Gelsemium is, I believe, the most valuable remedy we 
possess in serous inflammation of the choroid. This fact I first brought 
out in a paper published in the Hahnemannian Monthly some twelve 
years or more ago, and my experience since then has only served to con- 
firm my first impressions. I now always rely upon it in serous choroiditis, 
unless the local or constitutional symptoms point strongly to some other 
drug. In detachment of the retina, most excellent results have followed 


i' '. .. - 

t I 

140 Bubeau of Ophthalmology. 

its rise. At the Ninth International Congress, justheldin Washington, 
Professor Galezowski reported that in 152,000 cases of eye disease he 
had found detachment of the retina in 785. Among this number he 
had seen a cure effected in only 7. With homoeopathic remedies we 
can do much better than this. 

Dr. Hasbrouck : I have never had any satisfactory results from the 
use of Gelsemium in cases of detached retina, and believe that rest in 
bed, in recent cases, will do all that anything can, and that chronic 
cases are about hopeless. 

Dr. E. H. Linnell : Casts disappeared although the disease seemed 
to go on. Judged the curative effect to be from direct action upon 
the eye, and not through the general disease ; said kidney disease was 
gradually increasing. 

Had treated several cases of detachment of retina with Gels, with no 

Dr. Jonn L. Moffat : I have more than once relieved inflamma- 
tion of the lids, conjunctiva, and even of the iris, by neuralgic remedies, 
as Cedron and Spigelia. 

I always urge my patients in buying eye-glasses to get the long kid- 
ney-shaped case, so as to avoid doubling the spring, which otherwise 
would soon become distorted. 




J. Edwin Pratt, M. D., Chairman, - - New York City. 

Drs. Henry C. Houghton, - - - New York City. 

Wm. P. Fowleb, .... . Eochester. 

N. B. Covebt, Geneva. 

W. E. Rounds, --.--- New York Citv. 

F. Park Lewis, Buffalo. 



By Henry C. Houghton, M. D. 

Inflation of the middle ear is an established procedure in the prac- 
tice of aural surgery ; the methods by which it is performed have their 
advocates who are enthusiastic, or otherwise, as the case may be, their 
views being based on their own personal experience. 

Inflation by means of the catheter was first effected by a layman, 
who relieved himself of deafness by a tube passed to the mouth of the 
eustachian tube, through the mouth, rather "than the nose. Wilde 
claims that Cleland was the first to practice catherization in the usual 
way. Valsalva's experiment is the result of careful anatomical study, 
but was superseded by the catheter. Politzer's method is also the 
result of anatomical study and physiological observation ; it is the 
simplest and best method of inflating the tympanum. 

It must be admitted all methods of inflation are open to objection ; 
every agent for good may be perverted. The eustachian catheter is 
an uncomfortable necessity, even in the hand of an expert; an instru- 


142 Bubeau of Otology. 

ment of torture in the hand of a bungler ; a cause of death in certain 
cases of medica-legal history. Politzer's method was used without 
caution for a time, until patients (in whose hands it had been placed for 
weekly or even daily use) reported bad effects following its operation, 
then warnings were heard from aurists and its use has been restricted. 
- The late C. Th. Liebold, M. D., recognized this fact and cautioned the 
profession as to its ill effects. 
:* ;*• Study of the cases that are uniformly worse after iuflation has led 

>.; ' me to the opinion that the impairment of f miction is due to displace- 
ment of the malleo-incal articulation for we find that upon re-ad just- 
<~^ ment of the relations of the mechanism of the ossicles the function has 
:v*v not improved, but usually show the same distance for watch 

&•; -i as before inflation. Hence, the object of inflation should be the 
i patency of the tube, then the tension of the air in the tympanum will 

|,-x adjust itself ; but if inflation cause undue increase of the air pressure 

(:> > the membrana tympani is forced outward abnormally, and repeated 
'}.-) inflation simply adds to the previously existing defects. Noticing that 

0/ r writers advised inhalation or swallowing with closed nostrils, in order 

'/'• to readjust the displaced ossicles; also watching the effect of Lncae's 

'Q. .?'" " stemple " for producing direct pressure on the malleus in order to 

1{; overcome rigidity of the articulations, I have been led to modify 

Valsalva's experiment in the following report : 

As you are well aware this experiment is performed by closing 
the anterior nares and the mouth, then the attempt is made to expel 
the air from the lungs through the nose ; necessarily the volume of 
air finds one avenue of exit through the tube to the middle ear. 
Many patients discover this mode of relief inadvertently and prac- 
tice it to their detriment. Many physicians advise the practice till 
some story of bad results comes to their notice. During the last year 
I have directed my patients to close the meatus auditorius externus 
with the middle finger of each hand, to carry the thumbs downward 
and inward, closing the anterior nares gently but firmly, then exhale as 
usual. In using Politzer's air bag or the eustachian catheter the same 
caution should be observed, close the external meatus. What may be 
termed aural massage may be practiced by alternate inhalation and 
exhalation keeping the anterior nares and external meatus securely 

One case that has been under observation more than two years is a 
very marked illustration of the utility of this method. A strong, intelli- 
gent school girl of about fourteen had catarrhal inflammation of both 
tympana, suppuration had occurred several times as sequels of super- 

Bureau of Otology. 143 

ficial and parenchymatous tonsillitis. Inflation had been practiced by 
catheter and Politzer's method by competent practitioners till she had 
a dread of all efforts to inflate the middle ear. I used Politizer's 
method gently as possible, and satisfied myself that there was an 
unusual sensitiveness ; the patient would involuntarily cover both ears 
with her hands. During the past year I taught her this modification 
of Politzer's method and have the pleasure of reporting uniform 
improvement, as well as being greeted with a smile on the occasion of 
her visits. 

I have not offered this suggestion in order to set aside the methods 
in use, but all who are compelled to guard against the injurious 
results of rather heroic practice are glad of any suggestion which 
may tend to increase the effectiveness of accepted methods. As 
such only do I offer it to my colleagues. 


By Sayer Hasbrouck, M. D., 


Reference to the valuable work of Dr. D. B. St. John Roosa, of 
New York, shows that Dr. James Yearsley, of London, first introduced 
the artificial membrana tympani, having profited by information 
gained from a New York layman, who was able to improve his hearing 
by the use of a " spill of paper previously moistened, with cotton at 
the bottom of the passage," though Yearsley substituted cotton wool 
for the paper, which substitution until this day has continued in 
general use. 

Previous to Yearsley, Marcus Banzer, in 1640, and many others 
after him, recommended an hollow tube covered with pig's bladder or 
some similar substance, as a protection to the middle ear where the mem- 
brane had been destroyed, these might very properly have been called 
artificial membrana tympani, but they were not intended as an aid 
to hearing. • 

In 1853, Toynbee suggested another artificial membrana tympani, 
which, until this time, has been the one most frequently used. The 
Toynbee drum consists of a thin disk of rubber, to the center of which 
is attached a fine gold wire about an inch in length, so that it can easily 
be adjusted by the patient. 


144 Bureau of Otology. 

I know that aurists are Dot inclined to value the use of the artificial 
dram very highly, as they find that even though it may improve the 
hearing at first, the improvement does not last for a satisfactory length 
of time and the patients very shortly find it of more annoyance than 

From a knowledge of the fact that artificial drums tended to improve 
the hearing in many cases for only a brief time, I was led to believe 
that the drum must become easily displaced after being put into 

In seeking a satisfactory reason for this displacement, no fault could 
be found with the rubber disk or the wire attachment, as it seemed to 
answer every purpose for which it is intended, but from its location in 
the middle of the disk it tends to drag the upper edge of the disk from 
the remains of the membrane and ossicula. 

To fulfil its intended purpose an artificial membrana tympani must 
first be placed in contact with the remains of the membrane and 
ossicula and kept in position. 

In those cases where the Toynbee drum has been of continued bene- 
fit the floor of the meatus has probably curved upward, or there has 
been a slight adhesive secretion, gluing the disk to the membrane 
and furnishing the necessary support to the wire. 

I have tried to support the disk by making a double elbow in the 
wire, but this would turn and fail in its support. 

I finally had an artificial membrana tympani made after the follow- 
ing design : The disk is of thin rubber as in the Toynbee. 

The gold wire for adjustment spreads out into a V ; the V being at 

right angles to the stem, (like this V o), and should not extend 

above the center of the disk, to which is attached the wire for adjust- 
ment coming out at the lower edge. 

The V gives the necessary support to the disk, 
O th e w * re from the lower edge being about an 
inch in length allows of its easy adjustment. 

I will say right here that the artificial membrana tympani should be 
adjusted for the first time by the physician, with a hand mirror and 
reflected light, so that he can see when the disk has been trimmed 
down to fit smoothly, and if "necessary bend the wires to give the 
proper support. 

I have had the Vs made of different sizes in accordance with the size of 
the meatus. Many patients complain that the riveted end of the Toynbee 
wire causes a disagreeable irritation ; to overcome this I have attached 
the disk to the wire by cementing the V between two rubber disks. 

Bureau of Otology. 145 

As yet it has been used in but few eases, though all of these have 
proven very satisfactory. It is unnecessary to add that the artificial 
membrana tympani is not applicable in all cases of deafness, but for 
those in which a portion of the membrane is yet undestroyed, and the 
mobility of the ossicula patent, its use will generally give a fair degree 
of satisfaction. At first the drum should only be worn for a short 
time, but by degrees many will be able to use it more or less con- 

You will find that it acts as a protection to the mucous membrane as 
well as improving the hearing. ^ 

When it is realized how many cases of defective hearing begin in 
early life, and thus lay the foundation of a possible series of disadvan- 
tages and discomforts, it should be the aim of our profession to 
endeavor to overcome such defects by every means within our grasp, 
and it was this that prompted me to direct your attention to this new form 
of artificial membrana tympani which I have devised. 

The device is now presented to the profession with the hope that a 
more general use of it will confirm my experiences, and be the means 
of alleviating the condition of a large number of the unfortunate deaf. 


By Chas. C. Boyle, M. D., 


I wish to call attention to these growths on account of the intimate 
relation they bear to the chronic discharges which accompany a great 
many cases of suppurative inflammation of the middle ear, they being 
the product of it, and it is impossible to cure the original trouble until 
they are eradicated. They are found attached to some portion of the 
mucous membrane of the middle ear, generally at the posterior edge 
of the remains of the membrana tympani, which has been destroyed 
by the destructive changes. They are analogous in structure to 
exuberant granulations, occuring as a direct result of an ulceration, 
consisting of a delicate but loose stroma connective tissue and numer- 
ous # granulated cells. The surface of a mucous polypus is generally 
smooth and rounded, as it grows it becomes constricted at its attach- 
ment, forming a pedicle. They vary greatly in size, shape, color and 
consistence, their average size is that of a small bean. 

146 Btoeau of Otology. 


In cases of chronic suppuration of the middle ear, accompanied by 
a discharge which has long resisted treatment, one of the probable 
causes is the presence of a polypus, and it is impossible to cure one of 
these cases as long as this growth remains. It does not, as a rule, 
cause much pain, but by the obstruction it causes in the canal it pro- 
duces such unpleasant symptoms as stuffed sensation, deafness, tinnitus 
aurium and aural vertigo, besides being a constant source of irri- 
tation, thereby keeping up the discharge, and where large enough, will 
so obstruct the canal as to cause a retention of the purulent matter, 
inducing increased inflammation and danger of its extension to the 
meninges of the brain. 

The treatment for polypi begins with their removal, which is usually 
done with the wire snare, or if small enough by the curette, after 
which it is necessary to treat its base or point of attachment with some 
local applications or by the curette, until all vestige of it has disap- 
peared, otherwise it will soon return. Combined with this treatment 
we also use the indicated homoeopathic remedies. 

Will give histories of two or three cases treated thus : One was 
that of a boy, who had a chronic discharge from both ears, with great 
hardness of hearing. 

On examining ears, found auditory canals completely filled by two 
large polypi, one in each, about the size of a large hazel nut, project- 
ing from the canals in the form of a small round fleshy tumor. On 
closer examination found that they were connected to the edge of the 
posterior wall of the tympanic cavity by a pedicle. I removed them 
both by the wire snare, and treated the stumps by scraping off as much 
as I could with the curette and applied a dry powder of Monsel's salts 
(Ferri persulphate). Besides this cleaned the tympanic cavity with 
absorbent cotton and Hydrogen peroxide, and at the same time giving 
such remedies as Kali sulph., Thuja, and Silic., as indicated. After 
about a month's treatment the discharge stopped from one ear and all 
remains of the polypus had disappeared. The other ear still continued 
discharging, which was due to my not being enabled to remove the 
entire remains of the polypus, this continued until I succeeded in 
removing all traces of it, when the discharge ceased. 

Another case was that of a lady, who had had a chronic suppura- 
tion of the ear for a number of years, accompanied by aural vertigo. 

On examining ear found entire absence of the membrana tympani ; 
a polypus about the size of a large pea was attached to posterior wall 
by a pedicle, accompanied by a profuse yellowish, offensive discharge. 
I removed polypus by the snare and touched its pedicle with the 

¥,-'. ,..*^^«^.. 

Bureau of Otology. • 147 

Nitrftte of silver stick to prevent its returning. I then treated the 
suppuration of the ear by cleansing it with cotton and Hydrogen per- 
oxide, and blowing in Boracic acid powder, and gave remedies inter- 
nally, as Hep. s., Kali sulph. and Silic. Under this treatment improve- 
ment took place, but the aural vertigo did not cease until I gave her 
internally Onosmodium, which is a special indication for the employ- 
ment of this remedy in ear diseases, and while taking it she had quite 
a proving of the drug, developing symptoms which she had never 
complained of before and which ceased on stopping medicine. 

Within this last month have removed a small polypus from an ear 
which has been discharging for several years. I have been treating it for 
some time by applications and remedies, but with no result, but as soon 
as polypus was removed the discharge ceased with further treatment. 

These cases show the necessity of removing any polypi that may 
exist before attempting the cure of a chronic suppuration of the mid. 
die ear. 

Dr. Norton : This suggestion of Dr. Houghton's is a very wise 
one. The doctor also refers to the dangers of Politzer's inflation. I 
do not think that there is usually much danger from this method, 
but yet, in some cases, I know there is. I supposed, for years, that 
there was no danger, and used it indiscriminately, until a lady came 
to my office, with slight catarrhal inflammation in the middle ear ; 
only a very little inflammation of the drum, but moderate dullness of 
hearing. I used the Politzer's inflation ; immediately afterward 
she complained of a little pain. An examination showed that there 
had been a rupture of a blood vessel in the membrana tympani, 
which was densely filled with blood so that even the handle of the 
malleus could not \>e seen. 

The blood vessels in this case were evidently in a weakened state, and 
the inflation of the middle ear had produced a rupture. The hem- 
orrhage was readily absorbed and the patient perfectly recovered her 
hearing, but it taught me that there is danger from an indiscriminate 
use of the Politzer in acute cases. I have never seen any serious 
results in chronic inflammation of the middle ear. 

Dr. Hasbrouck : This new method of inflation that Dr. Hough- 
ton has given us this evening is one that, in a modified way, I 
have been in the habit of using for a long time. I first learned 
it in Dublin, at St. Mark's Hospital. In a case where one ear was 

Bureau of Otology. 

1 seemed to need treatment, whenever we used the Polit- 
1, we always advised the patient to pat his finger in the 
nd in that way we thought we supported the membrane 
>t in any danger of injuring it. I, myself, have at times 
rrhal condition of my left ear, and whenever I inflate it I 

my finger in my right ear ; and thus it has always 
lod familiar to me, in a one-sided way, so to speak. But 

its value in other cases, I am very glad to hear the sug- 
; Dr. Honghton gives to oa of protecting both ears. 

jhtom : I wish to add one word more in regard to the 
o which Dr. Kortou has referred. Dr. Liebold showed 
' that while great mischief may resnlt in acute diseases of 

ear, and particularly when the membrane is, as the Eng- 
s it, sodden, because the force applied would rupture and 
■foration in the form of a pin point, or a slit, in the direc- 
longitndinal fibers ; yet, it is by the lay use of the instru- 
nost mischief has been done. You have, in that class of 
;e unusually open, the so-called sclerosed condition of the 
In the acute or hypertrophic state, the walls of the tube 
sition all the while, notwithstanding what the external or 
uble may be ; but when this state of things has passed by, 
'-mucous tissue has been absorbed, if undue force is used, 
t unnaturally opened, and the ossicles are displaced, the 
being stretched until there is a demand for the various 
jgested by the German aurists for contracting the drum 
racticed by Dr. Liebold. Lacar devised an instrument for 
; the rigidity of the ossicles ; it was brought to me by Dr. 

Boston, theoretically it is admirable, bnt I do not think 
of extensive practical use. 

ohton : I believe the Society is not as much interested in 
subjects as when it was organized ; but if we have a 
iich will do certain work, we should be willing to try it. 
y of Schussler's work I find that Kali muriaticum is the 
;gested for just this form or process, and I have tried it 
i at the N. Y. Ophthalmic Hospital. I am satisfied that the 
b he made was correct. 

Rir : I would like to ask the doctor, if inflation be used 
itina, the same indication being present, what results there 
f any I 

Bueeau of Otology. 149 

Dr. Hasbrouck : I would state that that is just the case in which 
you would get the most advantage, provided you still have the 
ossicles and a portion of the membrane left. 

Of course, there are cases following scarlatina where there is very 
serious damage, and in these the artificial membrane would be of 
little use. 







Helene S. Lassen, M. D., Chairman, - - Brooklyn. 

Drs. Gertrude Goewey- Bishop, - - - Brooklyn. 

Susan 8. McKinnej, Brooklyn. 

"W. L. R. Perrine, Brooklyn. 

With invited co-operation of 

Drs. Georgia A. Cassidy, Brooklyn. 

M. Elizabeth Clarke, Brooklyn. 

Isabella M. Rankine, Brooklyn. 

Juliet Van Evera, ..... New York. 

Phcebb J. B. Watte, New York. 

Susan G. Dugal, Philadelphia. 

♦No report from the Bureau of 1887. 


Br S. S. McKinney, M. D., 


Of the many diseases to which children are victims, marasmus is to 
me one of the most interesting, from the fact that my success in enter- 
ing upon and building up a comparatively fair practice is, in a measure, 
due to the good results I have had in the treatment of this disease. 

One of my very first cases after graduation was that of a little 
patient afflicted with this disease, whose parents had become discour- 
aged with the old school treatment, and, as they stated, were willing to 
gis^e me a trial. 

The case was a typical one. I put forth my best efforts, supple- 
mented by careful nursing on the part of a loving and intelligent 


mother, and in time my little patient rounded out into a fine healthy 
looking child, rewarding my labors in its behalf by being the means of 
other children being brought to me, similarly afflicted. 

Thus all along the line up to the present time I find myself being 
called upon as one able to alleviate the sufferings, if not always able 
to cure the condition. 

Diagnosis : The word marasmus is derived from the Greek, mean- 
ing "I grow lean," and is used synonymously with the word atrophy. 
The name has been fitly chosen for the condition, and indicates a general 
waste of all the tissues from malnutrition. 

This disease may develop at any stage of infantile life, and is chiefly 
the result of the following causes : Unsuitable food, chronic vomit- 
ing, chronic diarrhoea, worim in the alimentary canal, and more espe- 
cially inherited syphilis. 

It is not always the result of functional derangements, but may be 
associated with, and is often the sign of, some grave organic disease. 
Although the exciting cause may sometimes be obscure, the condition 
is not difficult of diagnosis and is recognized by the physician at a 

The most prominent symptoms are : Emaciation exhaustion, hectic 
fever, vomiting, diarrhoea or constipation, dark and shrivelled skin 
or an oedematous condition of the same, anorexia or great voracity, 
thirst, sweats, bloated and hard abdomen, enlargement of the glands, 
great restlessness and nervous irritability, and a host of other symptoms. 

Prognosis : The prognosis depends very largely upon the exciting 
causes, the duration of its existence and the condition of the little 
patients at the time they are presented for treatment. 

If the condition is the result of bad feeding, either from unsuitable 
food or proper food injudiciously administered, which has provoked a 
chronic catarrhal condition of the digestive organs, thus interrupting 
normal digestion and assimilation, if not of too long standing, these 
cases generally yield to careful homoeopathic treatment without much 
trouble. If, on the contrary, extreme emaciation and exhaustion exist, 
complicated with some organic disease, or if of syphiltic origin, the 
prognosis is most unfavorable. 

Treatment : In taking charge of a case of this disease, I make it a 
rule never to promise a cure, but say I will do all I can to restore the 
little patient to health. 

I shape my course of treatment to suit each individual case as pre- 
sented, directing careful attention to the dietary and hygienic needs of 
the little patients and apply homoeopathic remedies according to their 


symptomatology. The following remedies have given the most satis- 
factory results in the treatment of this disease, either in assisting to pro- 
mote a cure or in alleviating the sufferings of such cases as have 
resulted in death : Aconite, belladonna, calc. carb., arsenicum, silicea 
bryonia, chamomilla, sulphur, ferrura, lycopodium, nux vomica, 
china, cina, mercurius and graphites. 

In connection with the homoeopathic remedies, I put the little 
patients on cod- liver oil (Iodo fervatea), using it topically as well as 
constitutionally, where there is great emaciation and dryness of the 
skin, and particularly in cases of syphilitic origin. 

Where children are artificially fed I have found Maltine, as prepared 
by Reed and Carnrick, a most excellent food diluted with good milk. 

I am now using, with good results, Carnrick's "Soluble Food," as 
it more closely resembles human milk in the proportion of its constitu- 
ents and digestibility than any other food at present obtainable. 

My rule is to have the child fed with a spoon (silver), and thus dis- 
pense with the nursing bottle, against which there are serious objections. 

If the child is still nursing, I direct attention to the mother's milk, 
and recommend such a diet as is necessary for a nursing woman. 

If thfe child is old enough to be weaned and I find the mother's milk 
at fault I order the child weaned and placed upon the proper food. 

Sun-light and fresh air are necessary auxiliaries in the treatment of 
this disease. 

While I feel that I have been successful in the treatment of maras- 
mus, I do not claim to have been more successful than the average 
homoeopathic physician (could we compare results), but I do claim that 
this disease, as well as all other children's diseases, stand a far better 
chance of recovery under homoepathic treatment, and this class of 
patients do much in the way of converting the public to our methods of 

As in my case, perhaps there are others who can remember some 
infantile disease they have treated successfully that has proved a step- 
ping-stone to a busy professional career. 




Selden H. Talcott, M. D., Chairman, - - Middletown. 

Drs. A. P. Williamson, .... Middletown. 

D. A. Gorton, .---.- Brooklyn. 

George E. Gorham, .... Albany. 

Trrus L. Brown, Binghamton. 

Wm. M. Butler, Brooklyn. 

C. Spencer Kinney, Middletown. 

With the invited co-operation of 

Drs. N. Emmons Paine, ------ Westboro, Mass. 

Clarence Bartlett, - Philadelphia, Pa. 


By Wm. M. Butler, M. D., 


Neurasthenia, or nervous exhaustion, is a disease characterized by a 
general derangement and disturbance of the functions of the nervous 

This disease was first classified and minutely described by the late 
Dr. Geo. M. Beard, in a paper read in 1868, before the New York 
Medical Journal Association, and published in the first edition of 
Beard and Rockwell's Electricity. Previous to this publication, 
although frequently encountered, it was regarded by the profession as 
one of the phases of hysteria, or scoffed at as merely the product of 
the patient's over-wrought imagination. Since this first publication, 

154r Bureau of Mental and Nervous Diseases. 

Beard's elaborate monograph upon this subject and descriptions of the 
disease by Dr. Hugh Campbell, of England, Prof. Erb, of Heidelberg, 
Grasset, of Paris and Rosenthal, of Vienna, and articles by less noted 
writers, have verified its existence and given it an established place 
among the disorders of the nervous system. 

Etiology. — Arising from a deficiency of that mysterious power we 
call nerve force, it may be caused by any one of a multitude of agencies 
which exhaust the nervous system. 

Although liable to occur in either sex and at any period of life, 
certain persons seem naturally susceptible to its invasion. These indi- 
viduals always attract by their brightness, sprightliness and keen wit. 
Favorites in the circle in which they move, their nervous system seems 
continually keyed above concert pitch. Extremely sensitive and utterly 
regardless of their natural resources in work or recreation, they invar- 
iably go beyond their strength. Precocious children, the pride of 
ambitious teachers and foolish parents, are found in this class, and too 
frequently is their life's work mined by their school and college honors, 
achieved in hours stolen from rest and sleep. Many a beautiful girl, 
with the plaudits of her teachers and friends over her valedictory essay 
ringing in her ears, steps from her graduating stage down into a life of 
pain and chronic invalidism produced by this disease. 

While these high strung, sensitive organizations are especially liable, 
none are exempt from this disease. Constant work and worry, whether 
over the intricate schemes and combinations of the counting-room and 
stock exchange or the endless cares of the household, may in time 
prostrate the man or woman of iron nerve. 

Sexual excess, in either sex, is one of the commonest causes. Con- 
stant seminal drain, whether from masturbation or too frequent inter- 
course, renders the male especially liable to the disease. 

Any acute disease which exhausts the general system and does not 
yield to treatment, may plunge the patient into the depths of neuras- 
thenia and leave him for months or years a sufferer from this dread 

In addition to the causes mentioned, woman may fall an easy prey 
to this disease from too frequent labors and miscarriages, profuse flood- 
ings, prolonged leucorrhoeas and chronic uterine troubles. Exhausted 
by any of these predisposing causes, the slightest shock or over-exer- 
tion may act as an exciting cause and produce in their full develop- 
ment any or all of the symptoms of neurasthenia. 

Symptomatology. — To describe the totality of the symptoms liable 
to be encountered in this disease would be to reverse every normal 

Bureau of Mental and Nervous Diseases. 155 

sensation which the nervous system is capable of producing. As well 
might you attempt to describe the changes of a kaleidoscope or paint 
the fleeting tints of the chameleon. • , 

From the top of the head to the tips of the toes, wherever a nerve 
is distributed, abnormal sensations may arise, singly or in the most puz- 
zling combinations. 

For convenience of discription we shall mention, in their natural 
order, a few of the common symptoms liable to be encountered. 

Mind. — A peculiar mental feature, often observed, is the presence 
of a variety of morbid fears, differing from insane delusions from the 
fact that the patient admits their foolishness but cannot throw them 
off — as an example I would cite a recent case of a friend of mine, 
a lady, who was afraid to go into her parlor. An example of what 
Dr. Beard calls " mysophobia, or fear of contamination," I encount- 
ered in a patient of my own some months ago. This lady, when walk- 
ing near any other person, unless she brought her reason to bear upon 
it, would involuntarily brush off her clothing. In both cases these 
symptoms disappeared with improved health. Others are greatly 
depressed and fear constantly some incurable disease or impending 
insanity, but the depression usually stops short of positive insanity. 

Head. — Dizziness of every form is of common occurrence. A vol- 
ume could scarcely describe all the head symptoms of which the suf- 
ferers complain. General and circumscribed heat or cold, bands about 
the head, opening and shutting of the skull, squeezing of the brain, 
drawings and pullings up and down, in fact every conceivable sensa- 
tion which an active imagination can invent, is liable to be encountered. 

In nearly every case sleep is more or less disturbed. While some are# 
almost absolutely sleepless, others only sleep in the first or last hours 
of the night. In all, even if they get an apparently sufficient quantity, 
the sleep fails to afford the needed rest and recuperation. When a 
drowsy state obtains, as sometimes occurs, we find the patient in the 
morning fatigued and unrefreshed. One of the most encouraging and 
reliable signs of permanent improvement is when the sleep becomes 
continuous and refreshing, even if the normal amount is not obtained. 

Chest. — Of the chest symptoms, the most troublesome are a sensa- 
tion of suffocation upon lying down and numerous functional derange- 
ments of the heart — palpitations, jumping of the heart, a feeling as if 
the heart stopped, and cardiac pains, often closely simulating those of 
angina pectoris. 

Digestive Organs. — The symptoms of the digestive tract are numer- 
ous, and often among the most difficult to overcome. Possessed of a 

15rt Bureau of Mental and Nervous Diseases. 

ravenous appetite or utterly devoid of all desire, and loathing the sight 
of any food, it is at times almost impossible to get the patient to take 
and retain *he nourishment which is absolutely necessary for the pres- 
ervation of life, to say nothing of the recuperation of their greatly weak- 
ened powers. 

In addition to their nausea, vomiting, flatulency, obstinate constipa- 
tion or diarrhoea, any or all of which, at times, we meet in the same 
patient, complaints are made of burnings or coldness in the stomach, 
trembling, faintness, drawings or a general relaxation. Some have crav- 
ings for the most indigestible substances, otherp obstinately insist upon 
their inability to take fluids, others strenuously oppose solids. How- 
ever tractible upon other points, in regard to the matter of diet the 
physician can rest assured that sooner or later he will meet with trouble 
and opposition. 

In adcHtion to the multitude of symptoms already enumerated, we 
may have tenderness of the whole or portions of the spine, burning in 
the spine, nervous chills, dull pain and aching in the different parts of 
the back, ataxic pains in the limbs, numbness and pricking in the 
extremities, coldness or burnjng of the feet and a feeling of general 
exhaustion upon the least exertion. Many are troubled with the most 
profuse sweatings of the hands and feet, or of the whole body. In men 
frequent emissions and deficient virility, and in women leucorrhoea and 
almost every form of uterine disorder are liable to occur. Profuse 
menstruation is another frequent accompaniment. One lady, at 
present under my treatment, has often fainted from her excessive 

Neuralgias of every variety torment the sufferers. A recent case of 
mine for days was subject to the most excruciating agony from attacks 
of intercostal neuralgia, producing the sensation of an ever tightening 
hoop around the chest. 

Many peculiar symptoms are also met with. I have now under my 
care a young lady who has been greatly troubled with swelling and 
inflammation about the nails of the great toes. Before coming into my 
hands she had undergone a very severe course of treatment at the 
hands of a chiropodist, for what he supposed to be ingrown toe-nails. 
Upon close examination 1 was convinced that the nails were not 
ingrowing, and the inflammation of the toes was but another one of the 
numerous symptoms of her disease, and aside from keeping them 
scrupulously clean, have paid no attention to them. The sequel has 
proven the correctness of any opinion, and the toes have ever served as 
a reliable index of her general condition — the inflammation increasing 


or subsiding with the fluctuations of the disease, and now, with approach- 
ing restoration to health, all signs of inflammation are disappearing* 

Such, in brief, is an outline of the most prominent symptoms of neu- 

Diagnosis. — The diseases with which neurasthenia is most liable to 
be confounded are organic diseases of the cord, hysteria and amentia. 

Upon a casual and imperfect examination, it may be difficult to dif- 
ferentiate neurasthenia from some of the organic diseases of the spinal 

The shooting pains in the limbs and the paralytic symptoms may 
suggest looomoter ataxy. The ability to stand with the eyes shut, the 
presence of the normal knee jirk and the absence of the Argyle Hob* 
ertson pupil, or reflex iridoplegia, as it is sometimes called, and the 
absence of the girdle sensation about the waist, soon dispels all doubts 
upon this point. 

In general, the changeable character of the symptoms distinguish it 
from those of organic nervous disease, which are usually fixed and 

Its increased activity of the reflexes in contradistinction from the 
diminished reflexes of organic disease of the cord is another pathogno- 
monic sign. 

Hysteria. — The absence of convulsions and the globus hystericus 
and the less common occurrence of ovarian tenderness and anesthesia, 
its more frequent occurrence in males, the great physical debility and 
course of the disease will usually distinguish it from hysteria. In some 
instances, however, hysterical symptoms are combined with those 
pathogomonic of the disease, and in these cases the diagnosis is more 

Anosmia. — The nervous diathesis, the usual occurence between the 
ages of fifteen and sixteen, the character of the pulse, often full or nor- 
mal instead of weak and compressible, the absence of cardiac and ven- 
ous murmurs, the usual absence of facial pallor, its almost universal 
disturbance of sleep, more frequent occurrence in men, and more 
chronic character, render it unliable to be confounded with anaemia. 

Prognosis. — The prognosis of the disease, under proper treatment, 
is usually favorable. The course, however, is ordinarily long and 
tedious, months and years often being passed before complete recov- 
ery is obtained. One great cause of the usual prolonged course of the 
disease arises from the conduct of the patients themselves, who, dis- 
couraged by their slow progress, are continually transferred from one 
physician to another, giving to no one a fair chance, the last one get- 
ting all the credit of the cure. 

158 Bureau of Mental and Nervous Diseases. 

Treatment. — The all important question in reference to neurasthenia 
is that of treatment. How are we to cure our cases ? In considering 
this question we must recognize the fact that no mere routine treat- 
ment can be successful. No iron-sided rules can be laid down appli- 
cable to all cases. 

Each case must be studied by itself in its entirety. The individual 
characteristics, the mental and physical symptoms, the surrounding 
moral atmosphere of the patient, the influence of any agencies which 
may have acted as predisposing or exciting causes of the malady, every- 
thing which can in any way affect the future course of the disease, 
must be considered before we decide upon a settled mode of treat- 

If we find the patient exhausted by slight exertion and worried by 
over sympathetic friends, we must insist upon isolation and absolute 
rest in bed, the physician and nurse alone being allowed access to the 
sick room. Yet this much lauded rest cure will not succeed with 
every case, and if not indicated will prove an obstacle to recovery. 

Many cases will improve more rapidly in their own homes, surrounded 
by friends, and while engaged in the routine of their daily duties. 

Some cases can be indulged in a generous general diet, while others 
must be limited to the articles most easily digested. 

All these questions must be decided by each individual practitioner, 
and the decision must be made anew with each fresh case, as no previ- 
ous experience is certain to be of value in the case in hand. 

In every case the physician must acquire the patient's confidence 
and gain supremacy over her mind or his treatment will be of little 

Massage and electricity will be found the most reliable adjuvants in 
a large majority of cases, especially when the rest cure is in progress ; 
nor should they be discontinued until the patient is far upon the road 
to recovery, or entirely restored. 

When the physical strength is sufficiently recuperated, great aid will 
be obtained by judicious outdoor exercise and enjoyable mental 

Yet, assisted by every external adjuvant, which he can bring to his 
aid, the physician must apply his highest medical skill or he will fail 
in working a perfect cure. 

In the face of an endless multitude of ever changing symptoms, if 
the homoeopathist seeks to find a simillimum which will cover them , 
all, he will soon find himself in a darker than Cretan labyrinth with no 
Anadne thread to guide his wandering steps. In choosing his drug 

Bureau of Mental and Nervous I)iseases. 159 

the physician must eliminate many symptoms, the mere fruit of the 
patient's overwrought imagination, and only consider those absolutely 
essential in the causation and continuance of the disease. When this has 
been done the most painstaking research of the materia medica will be 
required for the discovery of the correct remedy, but when the drug is 
discovered it tnust be allowed sufficient time to acomplish its work, and 
not be superseded by another to meet each passing whim of the patient. 
The list required by different patients is only limited by Allen's 
index. No one can successfully combat neurasthenia who is content 
with an annamentary more limited than the homoeopathic materia 
medica itself. 

Neusrasthenia and Melancholia. 

By Selden H. Taloott, M. D 


Neurasthenic conditions often terminate in melancholia ; and cases 
of melancholia resulting from nerve exhaustion are frequently afflicted 
with sudden maniacal outbursts. In evidence, we present the follow- 
ing case : 

No. 1908, at the Middletown Asylum, was a private patient ; female, 
38 years of age, married, seven children, housekeeper, and above all, a 
Baptist in religious proclivities. There was a predisposition to insan- 
ity in this case, the insane relatives being a brother and a grandfather. 
The patient has been passing into neurasthenic condition for over ten 
years, and during that time became gradually much depressed in 
spirits. Five weeks previous to admission, i. e., about June 1, 1886, 
this patient's melancholia became intensified and she had periods of 
great mental excitement and physical unrest. 

Her certificates stated : " I first noticed mental delusions July 1, 
1875. Have since had her under observation, and have noticed pecu- 
liarities of temperament which always prompted me to suggest quiet- 
ing surroundings. I visited her on the morning o^Jnly 9, 1886, and 
found her actively maniacal, constantly in motion, and incoherent in 
answer to questions. Fancies she has lost her chance for Heaven. 
Constantly gives utterance to screams and appeals for help. Attempts 
to jump from windows and shows a decided tendency to suicide." 

160 Bureau of Mental and Nebvous Diseases. 

Certificate No. 2 states : "An entire change in the patient's disposition, 
as she is now sad and despondent, moans and groans, whereas she was 
formerly bright and cheerful. Is sleepless, has delusions, thinks she 
has nothing to stand on and nowhere to lay her head. Inability to 
co-ordinate ideas; is impressed that everything is all wrong, that she is 
in deep trouble. Has slight hallucinations ; recently has become inco- 
herent and maniacal." 

The daily history of the case while under care and observation is as 
follows: When admitted, July 10, 1886, pulse 88, weight 93. 
Numerous bruises over body, especially on left hip. Pupils dilated. 
Weak and anaemic. Restless, constantly in motion. Would not reply 
to questions. " I am nothing but straw, I have no name." " They 
turned me around when they brought me here." "I can't do nothing." 
Tongue clean, bowels constipated. Arsenicum was followed by Rhus 

July 11 — Restless all night. " Oh please, these things don't belong 
to me." July 12 — Slept better. Eats well when fed with a spoon. 
Temperature 97.1. July 13 — Temperature 96.6 ; pulse 84. Says it 
is years and years since she ate anything. " I have been in this room 
ten years — years before I was born." Still much depressed and weak. 
Seems stronger though than when admitted, and not so restless. Time 
seems too long. Cann. ind. 6 x every two hours. July 14 — Talks 
better, stronger; temperature 96.8. July 15 — Restless, anxious 
and noisy. For the next three days the temperature averaged 
97 ; very restless, talking. July 19 — More restless. " Oh, don't, 
for pity's sake, don't." No one was near when she said this. July 
20th and 21st — Temperature 97.6; quiet; takes plenty of milk and 
beef tea. July 22 — Thinks things are running around on the bed and 
wall ; temperature 97.3. Stram. Ter Die. July 23 — Quiet ; pulse 
72$ strong; seems better; temperature 97.2. July 24 — More quiet, 
takes plenty of food daily; temperature 97.6. July 25 — Sees ani- 
mals going around over her bed ; temperature 97.5. Stramonium 
1st every two hours. July 26 — Quieter than usual; temperature 
97.6. July 27 and 28 — Temperature 98.2 ; quiet ; groans some ; Cham. 
1st every two hours. July 29 — Temperature 98. July 30 and 31 — 
Temperature 98.3 ; quiet. Aug. 2 — Weight 88 ; says she cannot eat; 
throat feels choked ; much quieter. Aug 4 — Says her throat is stop- 
ped up and she can't swallow. Aug. 6 — Talks pleasantly. Aug. 7— 
Talking much more rational ; stronger ; eating nicely and feeding 
herself ; gains strength daily ; cannot remember clearly about things 
which happened before she came in. Aug. 13 — Up and dressed for 

Bureau of Mental and Nervous Diseases. 161 

the first time ; very cheerful. Aug. 20 — A little nervous but gaining 
nicely. Aug. 21 — Menstruating ; discharges profuse and dark ; no 
clots or unusual pain ; slight headache and general soreness. Am. 1st 
every two hours. Aug. 22 — Became excited on receiving a letter from 
her husband. Aug. 23 — Quiet and mind clear. Aug. 24 — Says every- 
thing is confused in her mind ; hesitates in talking ; lips somewhat 
tremulous. Aug. 26 — Feeling better. Aug. 29 — Says she gets pretty 
well bewildered about the days. Sept. 2 — Weight 95. Sept. 6 — Mind 
still mixed. Sept. 9 — Thinks she eats too much and too often ; much 
less confused. Sept. 10 — A little better. Sept. 15 — Worrying less 
and is less confused. Sept. 18 — Doing nicely. Sept. 21— Not so con- 
fused. Sept. 23 — Slept poorly ; head feels bad to-day ; confused feel- 
ing in the back of the head. Mac. 3rd every two hours. Sept. 24 — 
Cold in head ; hoarse ; soreness in the chest. Sept. 25 — Cold no bet- 
ter ; throat feels fuzzy and thick. Sang. 3rd every two hours. Sept. 
26 — Better. Sept. 27 — Mind clear. Sept. 28— Says she is going to 
get well. Oct. 1 — Wakes at three a. m. ; bowels sluggish ; eats well 
but not hungry. Merc. 3rd. Ter. Die. Oct. 2— Weight 109. Oct, 4. 
— Is gaining and wants to go home. Oct. 5 — Improving steadily. 
Oct. 6 — Played on the piano to-day ; bright and cheerful. Oct. 10 — 
White, profuse leucorrhoea ; pain in the back. Calc. carb. 3rd. every 
two hours. Oct. 15 — Toothache between eight and nine every night. 
Merc. 3rd every three hours. Oct. 19 — "I feel first rate." Oct. 22 
— Menstruating ; head feels queer. Oct. 23 — A feeling of drawing 
in the top of the head with a sensation of heat that comes and goes. 
Bell. 3rd every hour. Oct. 24 — Head better ; toothache at times. 
Oct 26 — Seems entirely recovered mentally. Nov. 4, 1886 — Paroled ; 
weight 120 pounds ; left with husband. Aug. 15, 1887 — Discharged 

Here is a patient who for about eleven years has been steadily enter- 
ing the neurasthenic state. Her lowered temperature, her weakened 
pulse, her loss of flesh, her lack of energy, her pallor of countenance, 
and her depression of spirits, all bore evidence of the impoverished 
and de-energized condition of the great nervous centres. To treat 
successfully such a case amid the toiU and worriments of home seemed 
to be an impossibility. Her restoration began when she was removed 
from home cares and home irritations and consequent nerve exhaus- 
tion. Once away from home and secluded from anxious friends, she 
was placed in bed and afforded absolute rest. She was given an abund- 
ance of easily digested food. When we consider that the human body 
is composed of about eight-tenths water, we can readily understand 

162 Bureau of Mental and Nervous Diseases. 

how it is that liquid diet tends to rapid recuperation of exhausted and 
neurasthenic patients. For medicine, this patient received from time 
to time the indicated homoeopathic remedies, and by the effects of 
these remedies we believe that a return of health was promoted. As 
soon as the physical strength was restored in this case, the spirits of the 
patient resumed their normal elasticity, thus proving once again that 
a sound body is the only natural and substantial home for a sound and 
cheerful mind. 


By George E. Gorham, M. D. 


If there be a disease, the management of which is trying and tedious 
to the physician, and discouraging to those seeking relief, it is that 
generally known as nervous exhaustion. Whether it be named neu- 
rasthenia, hypochondriasis, spinal irritation, spinal anaemia, crankism 
or nothing but nervousness, the symptoms of all have the same general 
characteristics. I need not take your time to relate them here ; we 
have all heard them. The pathology of these cases is said to be 
obscure, but many hypotheses are formed to account for the various 
symptoms of which these patients complain. 

Perhaps the most prominent theory is exhaustion of the nervous 
centres ; and upon this theory the so-called nervous tonics, the different 
phosphated compounds, are bought and taken in large quantities by 
nearly all neurasthentic patients, and far too often they get no further 
advice from their physician than to take Fellows' Hypophosphites, 
Crosby's Vitilized Phosphates, or some similar compound. Perhaps 
they are laughed at as they pour forth their tale of woe, and told that 
it is nothing but nervousness — a term which would be nearer a correct 
diagnosis if it were put, something with nervousness. 

To assume that exhaustion is the cause, and tonics and stimulants the 
treatment for these cases, is as easy as it is common with the busy practi- 
tioner ; but in my hands it does not cure. To laugh at and ridicule a 
patient does not cure, and is often a cruel thing to do. That patient who 
comes to us filled with morbid fear, is restless in mind and body, startled 

Bureau of Mental and Nervous Diseases. 163 

by every sound and cries at trifling things, can be calmed and comforted 
and perhaps put on the road to recovery at that very visit by simply 
admitting to that patient, and to our own mind as well, that he is sick, 
and not think and try to make him believe he is simply nervous, fussy 
or foolish. There is a cause for these conditions of mind and body, 
and to tell patients so, and then make intelligent and earnest efforts to 
find and remove it, gives them a comfort and a ho^e that will enable 
them to bear patiently the flying pains, the palpitating heart, the tor- 
menting fears or the sad and painful emotions, until we have removed 
or alleviated the exciting cause, when they will slowly but surely grow 
into a degree of health gratifying to us and surprising to them. 

The causes would be divided, I suppose, after the manner of medical 
authors, into predisposing and exciting. I will omit mentioning the 
former. The latter, the exciting causes, may be divided into two 
general classes — mental and bodily. 

It is often difficult to find the mental cause, for the patient is slow to 
admit some secret sorrow or burning anxiety that is constantly harrassing 
his mind ; but they are frequent, and often found in some business com- 
plication, or among the many trials incident to social life. Unfortu- 
nately the physician can do little to remove these causes, but he can do 
much by kind words and encouragement to help the patient to bear 

The Bodily Causes, I have most frequently found within the pelvic 
cavity. In man an hypertrophied prostate, a chronic urethritis, a 
stricture or a phimosis may make him a wretched hypochondriac. 
Morbid conditions of the rectum, piles, fissures, strictures, and pockets 
and papillae, as described by Pratt, are often a constant source of irri- 
tation which exhaust the whole nervous system. The abuse of the 
sexual function by masturbation or too frequent intercourse, is a cause 
too well known to need mention. In woman the same conditions of 
the rectum often prevail, while any or all of the morbid conditions 
known to the gynaecologist may be the exciting cause of a persistent 

The Treatment, which has been quite successful in my hands, has 
been removal of the exciting cause when possible, rest properly pre- 
scribed, sometimes an hour each day, sometimes weeks at a time and 
sometimes an occasional day or two off from business, proper fcod 
eaten slowly and regularly, sufficient sleep, and the discontinuance of 
nerve tonics and stimulants of all kinds, excepting sometimes tea and 
tobacco in moderation, where they have* long been accustomed to it, 
(never allowing smoking), and the indicated homoeopathic remedy. 

164 Bureau of Mental and Nervous Diseases. 

The ones which have most often served me well are Nux. vom., Igna, 
Silicia, Cal. carb. Cal. phos., Verat. vir., Cactus grand., Hyper, Scutel- 
laria, Sepia, Phos. acid and Sulphur. The indications for these and 
many other important remedies may be found in that -most excellent 
article " Therapeutics in Spinal Irritation," by F. F. Laird, published 
in the North American Journal of Homodopaihy. The benefit 
derived from the removal of local irritation is shown in the follow- 
ing cases : 

Mr. L., aged 64 years, has for several years complained of being 
tired, being unable to go through the day without lying down for rest, 
sudden noises annoyed and pained him, he was emotional, crying with- 
out cause, and a firm conviction that he had but a few months to live 
had settled upon him. His face showed a tired and haggard expression 
and his sleep was unrefreshing — always disturbed by distressing dreams. 
He said he was worn out. The removal of a large internal hemorrhoid 
was followed by entire relief. He says it made a new man of him, and 
so it did. The tired look is gone, the sleep is quiet and refreshing, the 
hope and ambition of his earlier manhood have returned to him, and 
he has endured a hard, hot summer's work with no return of his 

Mr. W., aged 29, unmarried, a banker, sought relief of many dpc- 
tors, tried rest and change of climate, and the popular nervous tonics 
were taken without benefit His palpitating heart, his imaginary con- 
sumption, his wild, restless feelings when he attempted to work at 
his desk, and his great sense of exhaustion about 11 a. m. continued. 
Slitting up the fore skin for a congenital phimosis cured this man in 
one month, and he has had no return of his trouble now four years. 

Mr. H., unmarried, aged 28, an editor, complained of dizziness, ina- 
bility to do bodily or mental work, constant restlessness, poor sleep, 
pains in the knees and pain and soreness in each tuber ischii occasioned 
nocturnal emissions and a whitish sediment in the urine which he wa9 
hourly examining, carrying a bottle in his pocket for the purpose. The 
point of irritation in this man was found in the prostatic urethra, which 
the passage of graded steel sounds and the administration of Thuja 
12 x relieved, and his pains and nervous symptoms disappeared. He 
gained 15 pounds in three weeks, and has remained well for three 

Mr. M., an excessive smoker, met some reverse in business and began 
to worry. He soon became irritable, nervous, and slept but little. He 
complained of painful emotions, "nobody could imagine how badly he 
felt." His legs felt numb, his sexual power was wanting, and he was 

Bureau of Mental and Nervous Diseases. v 165 

very restless. Morbid fears came in to add to his torment, he would 
not walk, sit or ride alone. He became depressed and suicidal. For 
two years he rode or walked, and talked and cried almost constantly, 
excepting three to five hours sleep a day. He was a large, red faced 
man and looked the picture of health. Yet his trembling hands, his 
constant restlessness and his rambling conversation, often crying as he 
talked, told of trouble somewhere. The exciting cause in this case was 
a mental one, and every one of the eminent specialists whom he had 
consulted had advised tonics or stimulants, or both, and exercise. He 
had exercised and stimulated until he was a bundle of exhaustion and 
hyper-sensitive nerves, without hope or will power, a victim of his ever 
changing emotions. At this stage he took the case into his own hands 
by an attempt at suicide. I was then called and prescribed continued 
rest in bed, which the patient said he could not take. He was 
enforced for three days and Verat. vir. 3 X given and stimulants taken 
away, which soon changed our patient to a quiet, tired and sleepy man. 
He lay quietly in bed for three weeks, eating and sleeping well, when 
he was allowed to go to the sea shore, where his improvement went 
steadily on for a month. He spent the summer on a farm and then 
returned to the city, where he has been in his business for two years. 
Ign. 3 X did more to quiet this man than all the Bromide, Chloral and 
other hypnotics he had ever taken. 

Unfortunately we cannot locate and remove the cause in all cases as 
successfully as in those just cited. We then have to call to our aid 
massage, electricity, diet, rest, exercise and homoeopathic medication. 
The following case will show what can be done with the true 
sirnilimum : 

Mrs. Y. consulted me in May, 1887, after having been under 
treatment for 6 months for u nervousness." I copy from my case book: 
Mrs. V., aged 63, mother of six children, ceased menstruating at 56, is 
fat and apparently well nourished ; digestion good, bowels regular and 
not an ache or a pain. Pulse and urine normal, but complains of great 
weakness. If she reads cannot remember what she is reading, a walk 
of two blocks tires her. Visiting tires her so that she must leave the 
room. Sleeps badly and has a fear night and day that something 
will happen to her family. A fat woman with muscular and nervous 

Failing to find any local cause, I gave her Silicea 6 X trit. 4 times a 
day. Reported in a week, better; continues, the next week much 
better; continues remedy. In one month's time she could read, visit 

166 Bureau of Mental and Nervous Diseases. 

and walk a fair amount for one of her age, and enjoy it. She counted 
herself well, and the little powders a wonder. 

Silicea will cure sweating feet. Silicea will control too rapid forma- 
tion of pus. It cures also some forms of bone trouble, and it does it, I 
believe, by its power to correct that weakened or depressed condition 
of system which tends to the development of such troubles. It cured 
Mrs. Y. in the same way. It is often indicated in cases of neurasthenia 
and muscular weakness, and when it is I have found it more valuable 
than all the stimulants, nerve tonics and phosphorous compounds made. 


or THE 


L. A. Bull, M. D., Chairman* Buffalo, 

Des. George M. Dillow, - Now York OJty* 

Clarence E. Beers, - . ♦ Now York Cit\\ 

Malcolm Leal, Now York City* 

J. Montfobt Schley, .... Now York OUv. 

J. W. Dowling, Jr., .... Naw York Oit)\ 

With the invited co-operation of 

Prof. J. W. Dowling, - New York City. 

Dr. George E. Shelton, - - New York City, 


By J. M. Schley, M. D., 


During the last decade little advance has been made in the satisfactory 
treatment of laryngeal ulcerations of a tuberculous origin. In fact, 
phthisis now, as then, remains one of the most obstinate of chronic 
maladies to bring to a standstill or to cure. When we come to man 
up our personal experience in this trouble we must first of all divide 
the subject matter into three parts. First, an accurate diagnosis ; 
second, prognosis ; third, treatment. 

I will admit that in the incipient stage or stages of laryngeal phthisis 
some difficulty as to an absolute diagnosis is present ; we may readily 
confound it with a chronic larngitis, with its accompanying infiltration, 
a lupus (primary), a carcinoma, and more especially syphilis. There is, 
however, in all these diseases one fact that ha* itupn;H*<;d ma mora 


168 Bureau of Labyngology. 

than any other, and that is the invariable presence of tubercular 
deposit in the lungs when we find tubercle in the larynx, pharynx or 
nares. This is a point upon which I have exhibited much patience, 
and would not say a man had a phthisical larynx if his lungs were 
healthy. The infiltration in the pulmonic substance may not be great 
— may be unilateral — but it is to be found if we search again and 
again minutely, if it be necessary so to do. In 95 per cent, of those 
coming under my personal care it was where the third stage of phthisis 
wa6 already present when laryngeal symptoms first presented them- 
selves. Should I meet with a case presenting most of the macroscopical 
appearances of laryngeal phthisis, and no lung complication exisiting, I 
should first exclude beyond all doubt any syphilitic taint before declar- 
ing myself in favor of a tubercular state. Most laryngologists experi- 
ence the difficulty, sometimes from occult changes alone, in discrim- 
inating between a luetic and tubercular affection of the larynx. I have 
never witnessed phthisical ulceration of pharynx and nose without 
marked evidence of it elsewhere in the respiratory tract. Primary 
carcinoma and lupus of larynx belong to the list of curiosities. 

The oedema, the anaemia (generally), the infiltration, the points 
attacked by preference, the perichondritis, the superficial erosion, rap- 
idly spreading into an ulceration, with destruction of the soft and neigh- 
boring parts, is a familiar story to many of us. Now then, we must 
have no half-way opinion of our diagnosis, but must be absolutely cer- 
tain of our case before we may say this and that of an incurable mal- 
ady. This very day a gentleman presented himself in my office whose 
larynx I examined eight years ago. He has now, and had then, con- 
solidation of the upper lobe of his right lung, and the same to a much 
lesser degree in the left. The bases of both were emphysematous. 
His epiglottis on both surfaces, the walls of the larynx, true and false 
chords and upper margin of trachea were intensely red — congested — 
no infiltration or oedema as yet, but a quantity of tenacious, ropy 
mucus was visible. I could not claim with all fairness that he was 
suffering from laryngeal phthisis, for he was not. Two or three of 
the most important pathological appearances were entirely wanting, 
yet some specialist would eagerly have claimed a cure here. A few 
weeks in the mountains, without local treatment, speedily relieved the 
congestion, aphonia, etc., and he has so remained until this hour. 
First, then, let us be sure that we have a phthisical larynx. 

Prognosis. — In my own experience I have never seen a case of 
genuine tuberculous laryngitis get well. They invariably die. True 
it is, they may linger for weeks and months, with days of improve- 

Bureau of Laryngology. 169 

ment and with days of aggravation, until death closes the scene. 'About 
5 per cent, suffer from this complication of tabes, and I think among 
the lower classes the per cent, may run a little higher. 

Local Treatment, though bringing relief and comfort to the patient, 
is not,, curative in any sense of the word. Caustic or harsh local 
treatment must he condemned. The remedies most useful in the form 
of a spray, powder or liquid, are Morphia, Iodoform, Cocaine, Lactic acid, 
an oily solution of Menthol, Peroxide of Hydrogen, and the Balsams. 
The galvano-cautery, and scraping away deposits uijjer Cocaine 
and then applying Lactic acid in a 15 or 20 per cent, solution are 
highly 6poken of recently, also subraucus injections of Lactic ac. in 
larynx. When mucus clogs the way it should be removed by brush or 
spray before any local treatment is commenced. Of all these external 
applicants Lactic acid and Menthol hold out to us the most encouraging 
results as to a cure, if there be such a thing. We know fairly well 
what and how much each one of the above cited drugs may do. Some 
people do not tolerate Cocaine and we often have to resort to other 

General treatment must naturally be carefully supervised. 

Among homeopathic remedies we note Belladonna, Apis m., Lach, 
Cantharis, Mercury, Phosphor., Causticum and Calc. phos. They often 
render material help in our treatment. 

With the investigating turn of mind that seems now to pervade the 
whole profession I do not think that I overstate the matter when I 
claim that in the future phthisis of the larynx and lung will be safely 
classed among the curable chronic diseases. 


By Malcolm Leal, M. D., 


When our chairman notified me that he expected from me a three- 
minute paper on the conditions of the larynx requiring local treatment, 
I was inclined to reply in the language of the famous essay on The 
Snakes of Ireland, " There are none." Further reflection decided me 
in giving briefly my own experience with local treatment. 

170 Bureau of Laryngology. 

I am inclined to believe that local medication is seldom necessary for 
the completion of a cure, but that it is often desirable for the accelera- 
tion of its progress. Local applicationfe, exclusive of the mechanical 
or surgical procedure so often necessary, have for their object, either 
cleanliness, antisepsis, local or systemic absorption, or two or all of 
these combined. 

On reviewing my case records I find that local applications have 
been made with benefit almost exclusively in those conditions of the 
larynx characterized by loss of tissue. Laryngeal ulcerations from 
whatever cause appeared to demand local treatment. Those of syphil- 
itic origin especially were always combatted more successfully when 
local measures supplemented the constitutional. Especially valuable 
were the cleansing effect of the Hydrogen peroxide and germ-destroy- 
ing power of corrosive sublimate. Tubercular ulcerations were often 
treated by cleansing and insufflations of Iodoform, or in two cases by 
friction with Lactic acid ; but the only cures (and these of the ulcera- 
tion only) occurred in cases where the ulceration was of small extent, 
and in those the cure seemed to be due to the remedy given internally, 
which was, in each of the three cases recorded, the Nitrate of Mercury. 
In two cases of malignant ulceration local analglesia and deodorization 
were produced, that the condition of the patient might be more 

One case of typhus laryngis received no local treatment and recov- 
ered. My personal experience does not extend to cases of laryngeal 
ulceration from other causes than those mentioned, but judging from 
the behavior of similar conditions affecting other organs, I should 
expect to rely on local treatment in lupus, and to a subordinate extent 
in traumatic ulcerations. Inflammmations of the laryngeal tissues not 
terminating in ulceration have seldom called for local interference 
other than the application of thermal regulators, as steam, ice, etc., 
except in those cases attended by production of false membrane, where 
antiseptics and solvents were occasionally used, and in those cases where 
atrophic or hypertrophic conditions succeeded the acute attack. Of the 
former, a noteworthy case of laryngitis sicca, so-called, is among my 
records : 

A lady, aged about thirty-five, was found to have an atrophic condi- 
tion of the mucous membrane of nose, larynx and upper trachsa. She 
had been treated for a post-diphtheritic paralysis of the vocal cords 
some years before, and supposed that the paralysis had returned, as she 
was perfectly aphonic. Examination showed that the vocal cords were 
coated with inspissated discharge so firmly adherent that it had to be 

Bureau of Laryngology. 171 

detached with a probe when first seen. On its removal her voice became 
normal, though somewhat weak. In twenty-four hours the condition 
was as before, and it was only after several weeks daily treatment that 
spraying the parts became sufficient to remove the crusts, and at the 
end of four months she was able, by home treatment, to remove the 
crusts, which then formed more slowly. It is probable that she will 
never recover sufficiently to discontinue the local measures for relief. 
Two cases of laryngeal neoplasm (benign) are among those recorded, 
where local treatment was not used, and where the growths gradually 
disappeared while Causticum and Arnica were being used internally. 
Of the so-called chronic laryngitis I have had but few cases, and as 
these drifted away from active treatment their records are not specially 
instructive. While much more might be said of these and other cases, 
this brief record of personal experience will answer the purpose of 
provoking discussion, and serve to introduce the thesis that non-me- 
chanical local treatment seldom determines the cure. 


Dr. Beldin : Wish to inquire whether physicians present have tried 
Electricity Oxygen gas, or rectal gaseous enema in larynxgeal phthisis ? 
Whether tuberculosis is contagious or not ? Have known several 
cases where a healthy person slept in the same bed with tubercular 
patient and contracted tuberculosis themselves. 

Dr. Bull : Investigation by French physicians show that chickens 
have become infected by eating sputa, and persons who have eaten 
these chickens have taken tuberculosis. 

Dr. Boooook : In incessant cough with night sweats, benefit has 
been derived from Myosotis, tincture in water. 

Believe contagion due to the absorption of perspiration from the 
sick person, and also from nervous sympathy. 

Belated case of wife and made a plea in behalf of curability of 
phthisis. Thinks the craving for acid should give an indication. 

Has found Phos. ac. of benefit. Calc. phos. will relieve night sweats 

Dr. Schley : It is sometimes difficult to differentiate between 
syphilitic and phthisical conditions of the larynx. 

Asked for reports of internal medication. 

172 Bureau of Laryngology. 

Thought Dr. Gorham was mistaken in the subject of morning dis- 
cussion, which was laryngeal phthisis and not of the pulmonary variety. 

When we come to speak of the curability of phthisis pulmonum we 
must divide it into its two varities — catarrhal and fibroid. In the latter 
variety life is prolonged indefinitely if one lung be alone involved ; in 
the catarrhal, where both lungs are affected, the difficulty is more seri- 
ous and less easy to cure. 

Dr. T. M. Strong : The results of medication in the treatment of 
cases of consumption in our Ward's Island hospital are not very satis- 
factory Our patients are the victims of alcoholism or starvation and 
exposure. They come to us broken down in health and spirits. What 
palliating effects we obtain are due to the use of remedies like Phos., 
Silic., Calc. carb. and phos. and allied drugs. Cod liver oil is used in 
a few cases as an adjuvant. 

Our wards are overcrowded, and patients suffering from phthisis in 
all its forms fill them, but so far as these circumstances may have any 
influence we fail to find the slightest evidence of its transmission or con- 

We do not use any direct means of disinfection ; Carbolic acid crude, 
however, being used once a week on all the beds of the ward as a pre- 
ventative or destroyer of vermin. Lately we have been using the 
" crude sanitas" in the form of a spray, and find it a very agreeable 
agent, filling the air with the aroma of the pine woods Opportunity 
has not been given to test it as to any special effects upon individual 

Dr. Terry : In chronic bronchitis, in serious cases with high tem- 
perature, greenish expectoration, the inhalation of the vapor of Sul- 
phur has been used with marked benefit. 

Dr. Shelton : Have tried all local means and used remedies, and 
have never seen any permanent results in a case of genuine phthisis of 
larynx. In cases that were cured I believe diagnosis at fault. Vapor 
of a solution of Hydrastis and Glycerine with Carbolic acid was useful 
in relieving pain. 

I believe phthisis of larynx secondary to phthisis of lungs. 



H. M. Paine, M. D., Chairman, - - - A 

Dks. E. W. Bryan, 

J. N. Tilden, Pt 

George Allen, W 

F. Lengoenhaqer. U 

By George Allen, M, D., 


Dr. Parkes, in his famous work on " Practical Hygier 
"Tlie supply of wholesome water in a sufficient quantity i 
mental sauitary necessity." 

Dr. J. S. Billings, in Pepper's " System of Medicine," wri 
all the various preventable and movable causes of disease to 
attention of the physician engaged in practice in small t 
rural districts is directed, it will usually be found that the v 
ply is the most important, because it is in these localities 
most liable to become contaminated in such a way as t< 

The main sources of impurity and danger in potable wat 
in the presence of organic and mineral matters in suspensioi 
tion ; also certain deleterious, gases notably hydrogen sul| 
various products of organic decomposition; and also, in 
cases, of the specific germs of infectious diseases. 

The presence of chlorides in excess is regarded as evident 
tamination by urine or other animal excreta, and water s 
inated is justly regarded with suspicion. 
* No report from Bureau of 1B9T. 

174 Bureau of Climatology. 

The first step toward obtaining pure water should be the removal of 
the sources of contamination. Removal of the cause does not, however, 
at once remove the defect. Running water and living springs will soon 
free themselves of impurities if no more are added, but wells fed 
solely by surface water require considerable time to elapse before 
they will cease to be contaminated from a soil already saturated with 
foul matters. Such wells should not be used for a long time when 
known to contain contaminated water, and never until they have been 
thoroughly cleaned. 

The agencies affecting water unfavorably will, in a majority of 
instances, be found in defective drainage, or the near proximity of 
privies, cesspools or garbage heaps to the sources of water supply. 

The manner of correcting these evils will suggest itself when the 
features of individual cases are made known. It is the purpose of 
this paper to describe methods of rendering impure water wholesome. 

This may be accomplished by chemical processes and reagents or 
by filtration. 

Chemical Processes. — Of these distillation should, perhaps be men- 
tioned first, on account of the absolute purity of the product obtained. 
Distilled water is not, however, an agreeable beverage, being flat and 
insipid to the taste and not easy of digestion. Should necessity arise 
for its use it should be thoroughly agitated with air, and the addition 
of small quantities of calcium carbonate and of sodium chloride will 
render it more palatable. Most ocean-going vessels now carry a dis 
tilling apparatus for distilling salt water in case of necessity. 

Exposure of Water, in divided currents, to the action of the air is 
another chemical process of water purification, the rationale of which 
consists in subjecting water to the oxidizing influences of the atmos- 
phere. This plan is adopted in many cities for purifying water in 
connection with filtration, the water being thrown into the air by a 
fountain and falling into a minute spray. The water absorbs oxygen 
and is rendered more sparkling and palatable, deleterious gases are 
dispersed and a portion of the contained oxygen matter oxidized. 

Boiling as a method of purifying water, is one of considerable 
importance. It disposes effectually of ordinary impurities. Very 
hard water is rendered softer, hydrogen sulphide is expelled, any 
contained iron is diminished in quantity, and the amount of organic 
matter largely destroyed. 

Whether boiling destroys entirely septic germs is doubted by some, 
although Parkes thinks it hardly probable, and Sanderson stfys that 
septic bacteria are killed at about 230° F. Therefore, to insure the 

Bureau of Climatology. * 175 

destruction of disease germs, water should be superheated. Most fun- 
gus spores are killed by boiling. 

Precipitation^ as a method of purifying water, has various modes of 

In calcareous waters the addition of about six grains of alum to the 
gallon throws down a bulky precipitate of calcium*sulphate and alu- 
minium hydrate, which entangles and carries with it snspe nded matter. 
This method, however, cannot be depended upon to destroy septic 

The addition of lime to water acts in the same way by precipitating 
calcium carbonate, iron and a certain proportion of dissolved organic 

Sodium carbonate, with boiling, also throws down calcium carbonate, 
and a little lead, if that metal be present in solution. 

Potassium permanganate purifies water by the precipitation of man- 
ganic oxide, arising from the oxidation of organic matters, which are 
thus rendered innocuous. This action is said to occur only in warm 
solutions. This salt also removes the odor from water that has under- 
gone fermentation. " Condy's fluid " is the preparation usually recom- 
mended for this purpose, although Professor Chandler speaks of using 
the crystalized salt, and advises travelers to carry a small vial of it 
for the purpose of purifying suspected water. It should be added 
little by little, until after standing thirty minutes, a slight pinkish 
tinge remains. All organic matter has then been oxidized. A slightly 
yellowish color may remain, due to the manganic oxide, and this may 
be removed by the addition of a little alum. 

Perchloride of Iron cleanses water of particles of clay in suspension, 
and has ako considerable oxidizing influence upon organic matters. 

Charcoal is an agent generally supposed to possess considerable 
activity in purifying water. It is very effectual and rapid in its action 
upon decomposing organic matter. Its action on fresh organic matter 
is less certain, so that it cannot be implicitly relied upon to destroy 
disease germs contained in water. Moreover, if the charcoal is allowed 
to remain in contact with the filtered water, it, after a time, gives up 
again organic matter already removed. This suggests a caution against 
throwing loose charcoal into foul cisterns, and of using charcoal filters 
in cisterns so constructed that the medium is in constant contact with 
the water, as the purpose of the filter is thereby thwarted. 

This leads to the consideration of the subject of filtration as a method 
in very general use for the purification of water. 

Filtration is by some supposed to be limited in its action to sus- 
pended impurities, mud, sand, and various organic matters in suspen- 

176 Bureau of Climatology. 

sion. Professor Chandler so defines it in his article on " Water," in 
Johnson's Cyclopaedia. Parks, on the contrary, assumes that a prop- 
erly constructed and used filter destroys organic matter in solution, and 
hence is a water purifier in its strict sense, and not merely a strainer, 
which Chandler's definition would make it. 

Sand and grafel enter into the composition of many varieties 
of filters. These media are in general use for filtering the water 
supply of cities, employed alone, or in addition to other methods 
of purification. When used for this purpose a layer several feet 
in thickness is constructed from coarse stone, coarse gravel, fine 
gravel and sand, arranged in the order named. Through this the 
water percolates, and in so doing is deprived of all solid matter. 
Sand also arrests, to a limited extent,, dissolved constituents, both 
organic and mineral; but this action ceases after a time and the sand 
requires washing. It is uncertain whether sand oxidizes organic matter 
in filtration, though Parkes believes that some amount of oxidation is 
probable. For use in filters white sand is the best ; it should be care- 
fully washed, and if possible, heated to redness before use. 

Charcoal, both animal and vegetable, is much used in the construc- 
tion of filters, either by itself or forming a layer in a filter where sand 
and gravel are also used. Like sand, it removes suspended and dis- 
solved organic and mineral matter, but its powers over matters in solu- 
tion diminishes with use, and ceases entirely after a time. Parkes 
gives it as a rule that the charcoal in filters should be cleaned or 
renewed evGry three months. The caution already mentioned against 
allowing filtered water to remain in contact with the charcoal forming 
the filtering medium should be borne in mind when selecting a filter. 
If the filter is so constructed as to permit of this it is of no value. 

Spongy Iron is a substance highly spoken of by Dr. Parkes as a 
filtering medium. It is obtained by roasting hematite iron ore. It is a 
porous metallic iron, and not unlike charcoal in appearance. It arrests 
organic matter in suspension and oxidizes organic matter in solution. 
It imparts a little iron to the water, but beyond this yields nothing. 
Water filtered through this medium may be stored for a long time 
without undergoing any change. In this particular it is superior to 
charcoal ; for water filtered through charcoal soon undergoes changes 
and shows the production of living organisms. 

The so-called u Block Filters" are composod of various substances 
moulded into a block, through which the water percolates. 

Essentials of a Good Filter. — Dr. Parkes gives the following : 

1st. " That every part of the filter shall be easily gotten at for the 
* cleaning or renewing the medium." 


Bureau of Climatology. 177 

2d. " That the medium have a sufficiently purifying power, and be 
present in sufficient quantity." 

3d. " That the medium should yield nothing to the water that may 
favor the growth of low forms of life." This essential is not complied 
with by animal charcoal in a loose condition. 

4th. " That the purifying power be reasonably lasting." Spongy 
iron is said to last longest, though much depends on the relative 
impurity of the water to be filtered. 

5th. " That there shall be nothing in the construction of the filter 
itself that shall be capable of undergoing putrifaction, or of yielding 
metalic or other impurities to the water." This demands that noth- 
ing organic thall be used in the construction of the filter, and that 
metals shall be protected from the action of the water. 

6th. " That the filtering material shall not be able to clog, and the 
delivery of water shall be reasonably rapid." 

All filters should be frequently cleaned. The greater the impurity 
of the water the oftener will this necessity arise. Charcoal is the best 
cleansed by heating it to redness under cover, or by passing through it 
Condy's fluid (permanganate solution,) until it comes out a distinct 
pink color, then expose to the air and sun, and afterwards wash with 
distilled water. 

Block filters cannot be easily cleaned, though pumping air through 
them in a reverse direction and the employment of Condy's fluid, has 
been recommended. 

Spongy iron may be cleaned by heating to redness. 

All strainers that cannot stand the action of heat should be fre- 
quently renewed. 

Filtering is a system of purifying water in general domestic use. It 
is by no means a system devoid of danger. If constructed of improper 
materials, or used in an improper manner, filters are unsafe. If used 
too long without cleansing they may become actual sources of disease. 
All the impurities taken from the water remain in the filter, and as no 
one would drink water that had passed through a dirty strainer, no 
more should they think of using water drawn from a dirty filter ; 
and yet this is done by intelligent people. 

Filters are often used year after year without cleaning or renewing 
the filtering medium, the owners all the time supposing that they are 
using pure water, because it is filtered ; on the contrary they are often 
fostering the very evil they seek to avoid. 

This subject is one of many upon which the laity need information, 
and from no informant can the information be given more effectually 
than by the physician. 




Fred. S. Fulton, M. D., Chairman, - - New York City. 

Drs. W. Storm White, New York City. 

A. Wilson Dods, - Fredonia. 

J. Montfort Schley, - New York City. 

J. W. Dowling, Jr., - - - - New York City. 

♦Microscopic anatomy of the c arcinom ata 

By A. Wilson Dods, M. D., 
fredonia, n. y. 

When Dr. Fulton invited me to contribute a paper on the above 
subject I felt that although I could offer nothing new in regard to the 
histology of the carcinomata, yet I might possibly be able, by present- 
ing in compact form those points of structure which characterize this 
group of tumors, to save to some one a portion of the labor I have gone 
through with in order to become familiar with their histology, and at 
any rate I should be doing the work assigned me by the chairman of 
the bureau. It is, therefore, with a full appreciation of the fact that 
I may be, and very probably am, " Carrying coals to Newcastle, " that 
I present this paper to the Society. 

As other members of the bureau will consider the etiology and 
clinical history of these new growths, this paper will be confined as 
closely as may be to a description of their appearance as seen in the 
pathological laboratory and an endeavor to illustrate this by the aid of 
photo-micrographs. As a means of conserving your time as much as 
possible I shall omit the details of the preparation of the tissues for 
microscopic examination, referring to Dr. Geo. Sims Woodhead on 

* Photos referred to were exhibited at Meeting- during reading of Paper. 

Bureau of Histology. 179 

Practical Pathology and a paper of my own, " Practical Hints for the 
Examination of New Growths," which I had the honor to read before 
the Horn. Med. Soc. of Western New York last January, and which 
was published in the March number <5f the North American Journal of 
Homoeopathy, for a full description of all the steps necesssary to be 
gone through before the tissue is ready for the microscope. 

Before entering upon this subject matter proper it will be well to 
mention that there are no new tissue elements introduced into the sys- 
tem with which to build up the new growths, but that these forma- 
tions are composed of elements which are normally found in the body 
at some period of its development. This statement would appear to 
be superfluous, but one so often hears of " cancer cells " that it is well 
to combat the error on every occasion, for it would be absolutely 
impossible to say, on a microscopic examination alone, whether the 
epitheliaform cells found in " cancer juice " were " cancer cells " 
or not. It is the tissue elements taken together of which a tumor is 
composed, their amount, proportion and arrangement, which deter- 
mines its classification, and not the presence of any one particular form 
of cell. What I wish to make clear is, that although the true nature 
of a tumor is always better known after a microscopic examination, 
it would be folly to assert that its nature and proper classification 
could always be determined by such an examination, alone and 
unaided. It is always wise, and in some cases absolutely essential, that 
the clinical history be known, e. g., in the case of simple granulation 
tissue and round celled or mixed sarcomas. Without the clinical history 
it would many times be impossible to distinguish them, as both are 
made up of young connective tissue cells, embryonic blood vessels, 
and so on. 

The carcinomata, or epithelial tumors, may be defined as new 
formations made up of cells of epithelial type, with little or no 
intercellular substance, situated in irregular masses in the alveoli of 
a connective tissue stroma, which last has well developed blood vessels 
running through and supported by it. If it be further understood 
that these elements are in excess of the normal amount found in the 
tissue, are of high vegetative power and great malignancy, we will have 
a sufficiently clear conception of their nature for our purpose. 

There are four varieties of carcinomata, viz : scirrhus, eucepha- 
loid, colloid and epithelioma. I have adopted this classification rather 
than that given by Ziegler, which has, in addition to the above, simple 
carcinoma, carcinoma myxomatodes, cylindroma c, giant-celled (or 
myeloid) and melano-carcinoma, as these latter seem to be mere modi- 

180 Bureau of Histology. 

fications of one or other of the former, depending on rapidity of 
growth or degenerative changes, rather than any real difference in 
"Structure, and also because a multi plication of names only leads to 
confusion. The above objection might be urged against making a 
separate variety of colloid, and with some show of reason ; but as all 
authorities class it as a separate variety, and as it is so often found as a 
distinct tumor, I have thought best to speak of it separately. 

The first three, scirrhus, encephaloid and colloid, are alike in their 
general characteristics, their differences being in the proportion which 
the stroma and cell elements bear to each other, in the character of the 
epithelioid cells, and also in the condition of the stroma. 

Take a section from the advancing edge of as scirrhus cancer and the 
following may be noted : the infiltration of the adjacent tissues with 
small round cells, indifferent tissue ; then the characteristic stroma 
surrounding the alveoli, which in this part of the tumor contains well 
marked connective tissue fibers and nuclei ; and lastly the cells filling 
the alveoli, which it will be noticed are of distinct epitheliod form, and 
also that some of them have more than one nucleus. Now examine 
a section from the older part of the tumor near its center and it is at 
once noticed that there is a large increase in the amount of the stroma 
and that the alveoli are smaller and fewer in number. Closer inspec- 
tion will show that the stroma is not only greater in amount but has 
altered in character, having become more fibrous, and also that the 
epitheliform cells in the alveoli have not only decreased in number but 
are in various stages of fatty degeneration. 

Encephaloid or medullary cancer differs from scirrhus in the 
alveoli being much larger and more crowded with cells, and in the 
stroma being more delicate and more of the connective tissue type, 
less fibrous. (Photos. IV. and V.) Under a higher power (Photo 
VI.) it will be seen that not only is the stroma very delicate and 
cellular, but that the cells filling the alveoli have lost somewhat their 
epithelioid character, are smaller and that there are more free nuclei, all 
of which points to a more rapid growth. 

Colloid cancer is really one of the last mentioned forms in which the 
cells have 6hown a tendency to colloid or mucoid degeneration. The 
points to be noted are the large size of the alveoli and the thinness of 
their walls, also that the cells have either undergone or are undergoing 
colloid degeneration. I am sorry that I cannot 6how photo-micrographs 
of this variety as I am not in possession of a slide of colloid from 
which to get the negatives. 

The epithelioma form a distinct group of cancerous tumors, of which 
there are two varieties — squamous and cylindrical or columnar. 

Bureau of Histology. 181 

Squamous epithelioma is found growing from the skin and mucous 
surfaces, covered with squamous epithelium, and may 2 be said to be 
characterized by branching finger-like processes of epithelium pushing 
down between the papillae into the 'sub-adjacent connective tissue by 
the so-called cell-nests, which appear in the section as^round or ovoid 
bodies made up of conventric layers of flattened epithelium, the more 
dense portions of which stain yellow when picro-carmia is the stain 
used, and lastly *by the great increase of squamous epithelium at the 
free margin of the tumor. (Photos^VII, VIII, IX.) 

At the advancing margin of squamous epithelioma is seen the same 
infiltration of the adjacent tissues with round cells as was spoken of 
under scirrhus. This is well shown in Photos. X. and XI. 

Cylindrical, columnar or glandular epithelioma has its origin in the 
columnar epithelium of glands; most freqently perhaps in those'of the 
intestine, but also in the uterine glands, in the liver, mamse, etc. If 
the squamous variety may be said to advance by finger like processes, 
or columns of epithelium, so in the columnar-celled the same mode of 
growth may be assumed, except that in the latter case the columns are 
hollow and lined by cubical or columnar epithelium. These in the 
section (See Photos. XII. and XIII.) appear as spaces in the connec- 
tive tissue stroma lined with a single row of columnar cells. Ziegler 
segms to convey the idea that this lining is usually filled with epithe- 
liaf orm cells, and although I have only once or twice seen such a speci- 
men, 1 ^ would seem probable that this is the true appearance, as the 
cells might easily be washed out in the manipulations of staining, 
mounting, etc , and so give the section the appearance spoken of above. 

Xnspiceqc tamquam in speculum in vitas omnium 
Xuheo atque ex aliis sum e tie exemplum stbi. 

— Terence. 

department * IRecrologs 

A W. Holden, A. M.. M D., 


Glens Falls. N. Y. 

|tt gftemcrrtam* 

TTbomas Jefferson petttt, Ob. TB>. 
Cornelius ©rmes t Ob. 2>. 
Jacob ©♦ pbtlip, /!>♦ 2>. 
Hrtbur p. Jbollett, Ob. !>♦ 
%QVcn$o Ob. fsenson, /!>♦ 2>. 
XHUHfam Denrg 1Ran&el, Ob. 2>. 
Cbarles O. Glarft, Ob. W. 

Thomas Jefferson pettit, m. d., 


By H. M. Paine, M. D., 

Dr. Pettit was born in the town of Saratoga, Saratoga County, N. Y., 
July 4, 1817. He received a thorough English education in his native 
county. By unremitting effort, working during the day and hard 
study at night, he qualified himself for the profession of teaching. In 
this capacity he filled many positions, both in his native county and at 
Rome, Oneida County, N. Y., to which place he removed about the 
year 1850, to accept the principalship of the high school. 

Subsequently he was elected, after a stubborn contest, to the office 
of superintendent of public schools, his opponent being the Hon. O. B. 
Mattison, a well-known and popular politician of that period. 

Incessant application to the arduous duties of his office precipitated 
a prolonged illness, during which he was persuaded to make a trial of 
homoeopathic treatment through the personal influence of Dr. S. 0. 
Scudder, at that time one of the pioneers of the new system of practice. 

After his recovery, and at the expiration of his term of office, he 
entered upon the study of medicine under Dr. Scudder' s supervision, 
and was graduated from the Philadelphia Homoeopathic Medical Col- 
lege in the spring of 1854, and the following year from the New York 
Homoeopathic Medical College. 

In the summer of 1855 he removed to the village of Fort Plain, 
Montgomery County, N. Y., where for more than twenty years he 
enjoyed a large and lucrative practice. 

He was stricken with paralysis in the winter of 1876, after which he 
relinquished active professional duties, but was thereafter, for upwards 
of ten years, able to maintain a remunerative office practice. 

He died at Fort Plain, March 3, 1886, in the sixty-ninth year of 
his age. 


He was upright and conscientious in all his dealings with his fellow- 
men. He was an earnest advocate and zealous supporter of all 
measures having for their object the promotion of temperance, morality 
and religion in the community in which he so long maintained an 
exemplary and consistent daily life. 

He illustrated the true type of a self-made man. He had no resources 

Department of Necrology. 185 

other than a strong will supported by inflexible integrity and a deter- 
mination to overcome all reasonable obstacles. Having a desire for 
the acquirement of knowledge, he struggled, under many physical 
infirmities, during all his earlier years to acquire the elements of a 
sound, practical education. 

In the accomplishment of these laudable purposes he was eminently 
successful. The high positions as an educator which he subsequently 
held, and his marked success in the profession of medicine, attest in 
the fullest degree inherent power to overcome almost insurmountable 

Offices and 'Memberships. — He filled for several years the office of 
coroner in the village where he so long resided. He also held mem- 
berships in the Montgomery County Homoeopathic Medical Society, 
in the New York State Homoeopathic Medical Society and in the 
Medical Society of Northern New York, and, in 1870, was elected to 
its presidency. 

Resolutions of Respect. — The following resolutions were unami- 
mously adopted at a meeting of the Montgomery County Homoeopathic 
Medical Society, held April 13, 1886 : 

" Whereas, The Homoeopathic Medical Society of Montgomery 
County has learned with profound regret of the decease of a friend 
and fellow-member, the late T. J. Pettit, M. D.; therefore 

Resolved, That we receive with sorrow the news of his death, and 
regret Jhat the medical profession in this vicinity has lost an able repre- 
sentative, and this society one of its brightest ornaments and most 
active supporters. 

Resolved^ That we miss the genial manners that he brought to our 
meetings and his active and intelligent participation in all the proceed- 
ings of this society. 

Resolved^ That, remembering his many social and Christian virtues, 
our heartfelt sympathies are hereby extended to his family and friends 
in their d<?ep bereavement, with the fervent hope that their affliction 
may be lessened by the assurance that his memory will be cherished by 
a community in which he was so universally beloved. 

Resolved^ That a copy of these resolutions be presented to the family 
of the. deceased, entered on the minutes of this society and published 
in the county papers and homoeopathic medical journals." 

The following resolutions were unanimously adopted at a meeting of 
the Medical Society of Northern New York, October 27, 1886 : 

Resolved) That we, the members of the Medical Society of Northern 
New York, deeply mourn the loss by death of our esteemed associate, 
the late Dr. T. J. Pettit, by which we are deprived the fellowship of a 
revered and warm-hearted friend, and the public of an honored, 
wise and influential citizen. 

186 Department of Necrology. 

Resolved, That his recognized integrity of character, his intense 
desire to promote the advancement of medical science, his gentleness 
and urbanity of manners, are worthy of imitation, and prompt us to 
hold his name in respectful and enduring remembrance." 



By Asa S. Couch, M. P., 

Dr. Cornelius Ormes was born at West Haven, Vermont, August, 
4, 1807, of most excellent New England parentage. After receiving 
a thorough academical education, he entered upon the study of med- 
icine with Prof. Theodore Woodward, at that time the most noted 
surgeon of the Eastern States, and received the degree of M. D. from 
Castleton Medical College in 1832. After practicing for a time in 
partnership with his preceptor, he removed to Chautauqua County, 
N. Y., and opened an office in Panama, February 13, 1833. 

In that early day, this portion of the county and the adjacent parts 
of Pennsylvania were largely engaged in lumbering, and Dr. Ormes' 
surgical experience obtained under Prof. Woodward peculiarly fitted 
him for the exigencies constantly arising in that occupation. His ride 
soon extended into Northern Pennsylvania, then almost a wilderness, 
and his duties entailed upon him great hardships from the bad roads 
which he was compelled to traverse and the severe exposure to which 
he was frequently subjected. The success which attended his practice 
however, soon gained for him a high reputation, which was increas- 
ingly enhanced down to the time of his death. 

As the country became more fully occupied and settled, the acci- 
dents of pioneer life necessarily diminished and the doctor turned his 
attention to new fields for the employment of his surgical ability. He 
made a special study of ovarian diseases and soon established a national 
reputation for the treatment and removal of ovarian tumors. During 
his life he removed a large number of these and other new formations 
and he continued to operate successfully for their extirpation up to 
within a few months of his decease. In two of his ovariotomies, the 
uterine appendages were all involved, the tumor in one being of the 
colloid variety and weighing fifty-one pounds, while the uterus meas- 
ured eleven inches in length, was extensively sphacelated from long 
pressure, and its cavity wholly obliterated. The entire mass was sac- 

*In No. 6 (June) Vol. VII. (1886) of the Physicians' and Surgeons' Investigator. 


Department of Necrology. 187 

cessfully removed and the patient still lives in the enjoyment of excel- 
lent health. 

In 1863 the doctor removed to Jamestown, and the better Held 
greatly enlarged his already extensive practice. 

In 1872 he was called to the chair of Obstetrics and Uterine Surgery 
in the Detroit Homoeopathic College and discharged its duties with 
marked advantage to the college and the cause of homoeopathy. Dr. 
Ormes was first instigated to examine the new system by Dr. James 
Birnstil, then of Westfield, N. T., afterward of Pittsfield, Mass. 
After much study and a careful comparison of results from the old 
and new systems, he gave in his adhesion to homoeopathy and has con- 
sistently practiced it since 1848. 

Dr. Ormes was, at the time of his death, and for many years had 
been, President of the Homoeopathic Medical Society of Chautauqua 
and Cattaraugus counties, was one of the physicians from Western 
New York who assisted to re-organize the State Society in 1861, and 
in which he was a permanent member at his decease ; was a member 
of the new Homoeopathic Medical Society of Western New York 
and a *' Senior " in the American Institute of Homoeopathy, he having 
been elected a member in 1856. In all of these societies he occu- 
pied a prominent place, and in all was the frequent recipient of posi- 
tions of responsibility and honor. It will thus be seen that Dr. Ormes 
was gathered u like a shock of corn fully ripe." 

Few physicians have acquired as extensive and enviable a reputation, 
and none will be more missed by the profession for those genial and 
excellent qualities of manhood which shed an additional luster upon 
the achievements of an intellectual life. He died at Jamestown, N. Y , 
20th of April, 1 886, aged 79 years. 



The subject of this sketch was born in Claverack, N. Y., on the 
22d of November, 1824, where his youth was passed and his education 
acquired. His medical education was received at the widely known 
Vermont Medical College, located at Castleton, where so many of our 
ablest physicians at the North acquired the principles and instruction 
which answered them in such good stead in after life. Here he 

188 * Department of Necrology. 

received his medical degree on the 24th of November, 1847. He first 
embarked in practice at Austerlitz, Columbia County, N. Y., where 
he married Jane Elizabeth Brown, who still survives him. He 
removed to Catskill, where he commenced practice in the early spring 
following the advent of the cholera epidemic. Here, in the face of 
strenuous opposition from the physicians of the old school, he bravely 
made his way and as steadily gained in practice, which in the course 
of time became extensive and remunerative, and at the time of his 
death was the senior and leading physician of the place. For many 
years he was the only homoeopathic physician of the vicinity. He was 
a prominent member and president of the school board for many 
years. He filled many positions of honor and trust ' through along 
life of busy usefulness, and all his responsibilities and duties were dis- 
charged with promptitude and fidelity. He was United States Exam- 
ining Surgeon for Pensions, Health Officer, a member of the masonic 
order and of the Dutch Reform Church, and President of the Colum- 
bia County Medical Society. He was elected a member of the New 
York State Homoeopathic Medical Society in 1881. He was the third 
member of his family to adopt the medical profession, his brothers 
John and James being also physicians. 


His sickness began with a severe attack of acute rheumatism in 
December, 1886, followed by metastasis to the heart. His condition 
was alarming from the first, and death was imminent on several occa- 
sions. During several of these attacks he was so fortunate as to have 
the prompt attentions of his physicians, whose remedies were imme- 
diately successful in relieving his condition. With the early spring 
and its genial revivifying influence he was apparently better, but 
undertaking to resume his labors too soon, his bodily infirmities were 
too powerful for the determined will power with which he sought to 
push forward in the routine of his work and business. He was again 
stricken down, this time with paralysis and aphasia. Rallying a few 
times, he at length succumbed, and on the 25th of April, 1887, death 
came as a welcome relief to the terrible sufferings he had so long 
endured. After examining showed that blood poisoning had super- 
vened and that his case was beyond all reasonable hope of recovery. 
His loss was deeply and generally lamented. He left a wide circle of 
patients, and still wider of friends, to whom he had endeared himself 
by his ready sympathy and kindly generosity. By his death the pro- 
fession lost a skilful, worthy and honored practitioner, and the public 

Department of Necrology. 189 

at large a valued and valuable citizen. He left surviving him a widow 
and two children to deplore his lose. 

" Press on ! for it is godlike to unloose 
The spirit and forget yourself in thought ; 
Bending a pinion for the deeper sky, 
And, in the very fetters of your flesh, 
Mating with the pure essences of heaven ! 
Press on ! i for in the grave there is no work, 
And no device.' Press on ! while yet you may." 



Arthur P. Hollett was born on the 11th of April, 1847, at Geneva, 
Ontario County, N. Y. Eichard T. Hollett, his father, was of Eng- 
lish extraction, the family having emigrated to this country about the 
year 1790 and first locating near Smyrna, in Delaware. His father 
was a printer and publisher. His mother, Margaret C. Bruce, was born 
in Scotland, and came to this country with her parents when she was 
quite young. His father, eminent for his piety, was for a long period 
an elder in the Second Presbyterian Church of Auburn, N. T. He 
died at the comparatively early age of thirty-five, his (Arthur's) mother 
surviving a few years later, when the subject of this sketch was left 
alone at a tender age to struggle as best he might in the great battle of 
life, not only for mastery, but even for the poor boon of existence. 

u Thus at the flaming forge of life 

Our fortunes must be wrought, 
Thus on its sounding anvil shaped 

Each burning deed and thought." 

His early education was received under the care of his cousin, Prof. 
W. W. Runyan, at the Sonora Academy in Steuben County. Before 
the curriculum of his academic studies was completed the civil war 
broke out. Animated by the patriotic fires which stirred the life 
blood of so many gallant youths at the North, he aided in raising and 
organizing a company, mostly composed of his fellow students, which, 
under the command of one of his teachers, was consolidated with the 
189th regiment New York volunteers, and mustered into the United 
States service in September, 1864. Its record was carved in the fore- 
front of battle 

" Mid flame and smoke, 

And shout, and groan, and sabre-stoke," 

190 * Depabtmbnt ojp Necrology. 

at Hatcher's Run and Five-Forks, and Appomatox. His regiment 
was one of the few New York commands which had the honor of 
participating in the grand review at Washington at the close of the 
war, after which it returned to Elmira and was mustered out on the 
9th of June, 1865, the war being at an end. 

With the close of his military career, with its hurry and worry, 
and mortal risks, young Hollett, well seasoned to endurance and 
application by the experiences, fatigues and hardships of camp life, 
applied himself to the study of medicine in the office of the late Dr. H. 
S. Benedict, of Corning, Steuben County, N". Y. When sufficiently 
advanced, he matriculated at the Homoeopathic Medical College of 
Pennsylvania at Philadelphia, from which institution he graduated in 
March, 1869. Soon after receiving his degree he opened an office for 
the practice of medicine and surgery at Havana, Schuyler County, N. 
Y., where his pleasing, genial ways, his affable, courteous deportment 
speedily won for him a host of friends and a large and lucrative prac- 
tice. From this time forth his progress was upward and onward. He 
was prominent in the councils of his school. He was largely instru- 
mental in organizing the Schuyler County Homoeopathic Society, and 
also of the Southern Tier Society. Having served as delegate to the 
State Society in 1872, he was the following year nominated, and, in 1874, 
elected to permanent membership therein. In 1879 and 1880 he served 
as corresponding secretary, and in 1881 he was chosen recording sec- 
retary of the State Society, and acted in that laborious capacity for 
three consecutive years, discharging its onerous and exacting duties 
with marked ability, fidelity and conspicuous energy. 

" Finis Coronal opusP 

Besides holding the office of secretary, Dr. Hollett was elected 
third vice-president of the Society in 1884, and first vice-president 
in 1885. 

During the years of his membership in the State Society he was a 
frequent and able contributor to its Transactions. He was elected a 
member of the American Institute of Homoeopathy in 1874. Speak- 
ing of his personal character and professional relations, one who knew 
him intimately and well, indeed better probably than any other, says 
of him : " The intellect of Dr. Hollett was very clear and discrimin- 
ating. He sought to do everything he attempted with precision. 
Modest and retiring in manner, gentle and sympathetic by nature, he 
was loved best by those who knew him best. He was always ready to 
go wherever there was sickness and suffering. He sacrificed his life 

Department of Necrology. 191 

in thus doing his duty. He was a careful, conscientious, Christian phy- 
sician, beloved by his patients and respected by the profession. * * * 
By Dr. Hollett's death homoeopathy has lost a staunch and enthusias- 
tic supporter, suffering humanity a sympathetic and skillful friend, 
the medical profession one of its brightest ornaments, and the com- 
munity in which he lived one of its most useful citizens." 

In his practice he had latterly made obstetrics a leading specialty, 
in which it is stated that he never lost a case. While treating a fam- 
ily suffering from diphtheria he contracted the disease himself, and 
after an illness of only a few days died on the 29th of September, 
1887, lamented by all. To add to the poignancy and affliction of his 
surviving friends, his only child, a promising lad of thirteen years, 
took the disease from his father and died on the 17th of October 

" Brevis a naturd nobis vita data est; at tnemoria bene redita vita 



Dr. L. M. Kenyon, one of the most able and prominent homeo- 
pathic physicians in the western part of the State, was born at Sheri- 
dan, Chautauqua County, N. Y., March 18, 1821. He received a good 
English education in the academy at Jamestown, N. Y., and immedi- 
ately on leaving school in 1836, began the study of medicine with Dr. 
Samuel Foote of that place. He afterwards studied with Dr. Carlton 
Jones, of Westfield, and attended his first course of lectures at the Col- 
lege of Physicians and Surgeons of Western New York, at Fairfield, 
in the winter of 1838-39. His second course was at the Albany 
Medical College in 1843-44. Soon afterward he began practice as an 
allopathic physician in Warren, Pa., and later removed to Youngs- 
town, Pa. After remaining therefor two years he went to Westfield, 
N. Y., January 1, 1846. 

Mrs. Kenyon being taken very sick at this place, and given up by 
her husband and his partner, Dr. Carlton Jones, of Westfield, she was 
restored to health by the treatment of Dr. W. G. Wolcott, a homoeop- 
athic physician. In this way Dr. Kenyon's attention was called to 
the superior advantages of the Hannemannian treatment, and on June 

192 Depabtment of Necrology. 

1, 1846, he began the practice of homoeopathy, which he followed for 
over forty years, with pre-eminent success. While living at Westfield 
he was postmaster of that place during the years 1854-55. 

Removing to Buffalo, July 1, 1856, he entered into partnership with 
Dr. N. H. Warner, at that time the most noted physician in Western 
New York. This partnership continued until Dr. Warner's death, in 
1860 For the past thirty-one years, with the exception or two years 
spent in the South for his health, Dr. Kenyon has practiced in Buffalo. 
His skill and success in his profession and his true, upright character 
having been recognized by one of the largest practices ever secured 
by a physician in that city. 

In 1865 Dr. Kenyon was proposed as a permanent member of the 
State Homoeopathic Medical Society, and elected as such the year 
following. The same year he was made third vice-president of the 
same, and in 1874 was chosen president of the Society. In 1883 he was 
recommended for the honorary degree of M. D., conferred by the 
Regents of the University of the State of New York, on those members 
recommended by the Society. 

In 1853 Dr. Kenyon joined the American Institute of Homoeop- 
athy, and, on the expiration of the proper time, became one of the 
senior members thereof. He has been president of the Erie County 
Homoeopathic Medical Society, and was the first president of the 
Homoeopathic Medical Society of Western New York, organized about 
three years ago. He was also for many years Supreme Medical Exam- 
iner of the Royal Templars of Temperance. 

The doctor was a charter member of the Prospect Avenue Baptist 
Church of Buffalo, and for the past twelve years, one of the revered 
and honored deacons of the church. 

For the past three years Dr. Kenyon had been suffering from angina 
pectoris, but still continued his practice, only giving up obstetric and 
night cases to his son, W. B. Kenyon, M. D. On the 8th of October, 
1887, he was taken sick and suffered a great deal from then on, 
especially the last two weeks of his life, till death came to his relief, 
and on the 25th of November he passed away. His remains were 
buried at Westfield, N. Y. He leaves a widow, and his son, Dr. W. 
B. Kenyon, succeeds to his father's practice. 

Beside the medical societies of which he was a member, Dr. Kenyon 
belonged to the New Era Lodge of Odd Fellows. He was the first 
master of the lodge of Ancient Landmarks, No. 441, F. & A. M. and 
was a member of Keystone Chapter and of Hugh De Payne Com- 

Depabtmbnt of Necrology. 193 

inandery, Knights Templar. He had also attained the 89d degree of 
the Scottish Bites Masonry. 

Dr. Kenyon was a benevolent Christian physician, and was identified 
with most of the public charities of Buffalo, and daily gave gratuitous 
services to the poor. He was a man ever ready to lend a helping 
hand to a brother practitioner, and most of the homoeopathic physicians 
of the city, and the country round about, were wont to come to him 
for consultation, and it is a common feeling among his professional 
brethren that they have lost a good and safe counsellor as well as a true 
and faithful friend. 



Dr. William H. Randel was born at Albany, N. Y., August 28th, 
1832. Under the supervision of his uncle, the late William R. Weeks, 
D. D., he acquired an academical education at Newark, N. J. He 
entered upon the study of medicine in the office of Doctors J. A. & H. 
M. Paine, in Albany, and attended one course of medical lectures at 
the Albany Medical College during the session of 1849-50. In the 
spring of 1851 he was graduated from the medical department of the 
University of the City of New York, and immediately afterwards began 
the practice of homoeopathy in his native city. In addition to the skill 
gained by study and the exercise of his profession, in order to fit him- 
self still further for his duties the greater part of the year 1867 was 
spent by Dr. Randel in a tour through the principal cities of Europe, 
at which time he visited many hospitals in England and on the Conti- 
nent, and pursued special courses of study in several of them. 

He was present at the first meeting of the Albany County Homoe- 
opathic Medical Society in 1861, when its organization was effected, 
and in the year 1865 was elected its president. He was appointed a 
delegate to the State Homoeopathic Medical Society in 1862, 1866, 
1867, 1868, 1870, 1871 and 1873, at which last mentioned date he was 
elected to permanent membership therein. In 1855 he beame a mem- 
ber of the American Institute of Homoeopathy, and on account of a 
membership therein of twenty-five years, became a senior member 
thereof in 1880. 

With the history and progress of the Albany City Dispensary and 
Homoeopathic Hospital, Dr. Randel was closely identified, being present 

t» ^ 

194 Department of Necrology. 

at its organization in 1868. He was untiring in his labor to advance 
its interest and enlarge its sphere of usefulness by obtaining donations 
for its support, in his efforts in the direction of the care and treatment 
of the patients therein, 'and in the use of such measures as were best 
calculated to further its progress and establish it on a permanent and 
abiding foundation. From 1868 to 1872 he was a member of its board 
of trustees, since which the board has been made up solely of non-medi- 
cal members. He was also a member of the medical staff and one of 
the consulting physicians from its inception to the time of his death. 

During the night of Mondaj 7 the 12th of December, 1887, Dr. Han- 
del was attacked by paralysis from which he did not recover, dying on 
the morning of Wednesday the 14th. He had been married twice, his 
second wife and two children surviving him. 

A special meeting of the County Homoeopathic Medical Society was 
held on the evening of the 14th, at the office of Dr. Pratt, to take 
appropriate action on the death of their colleague. The following 
excerpts show the esteem in which he was held by his professional 
brethren, and the reputation of the man. At that meeting Dr. Pratt 
said " that he had known the deceased since 1854. Dr. Handel pos- 
sessed a sanguine, ardent temperament, which led him to inspire his 
patients with hope and confidence, even in the presence of the most 
unpromising conditions. He fortunately combined many desirable 
qualities of mind and heart which constitutes a successful physician, in 
the exercise of which he attained eminence in his profession. No 
physician in Albany attended more strictly to professional duties. 
With the exception of a trip to Europe a few years ago, his absence 
from the city has been a rare occurrence. Possessing a vigorous con- 
stitution, he was seldom disabled by illness from attendance upon any 
cases requiring his services. In the death of Dr. Randel this society, 
of which he was a life-long and honored member, has met with a loss 
we sincerely mourn." 

Dr. Paine then spoke substantially as follows : " My acquaintance 
with Dr. Randel extends over a period of more than forty years. We 
were for several years schoolmates, and later he pursued the study of 
medicine in my father's office. Dr. Handel's life illustrated the usual 
characteristics of a self-made man. He acquired an academical educa- 
tion by hard study at night. By dint of close application, at twenty-one 
years of age he had qualified himself for attendance upon medical lec- 
tures and had saved a sufficient sum to pay all necessary expenses. 
After graduation he began practice at Albany, where, by persevering 
effort, he succeeded in building up a large and lucrative practice. 

Department of Necrology. 195 

He was » earnest and persistent worker in the profession. His 
time was wholly devoted to its duties. He seldom attended a place of 
amusement or spent an hour in recreation or change. He never 
allowed himself any rest. He devoted his earlier ypars to building up 
a name as a faithful and reliable practitioner and in later life continued 
the even tenor of this way unchanged. He possessed in an unusual 
degree the power to inspire his patients with confidence. Their regard 
for him as a true friend was so strong that their confidence in his 
ability as a physician nsver flagged.' He was, to an eminent degree, a 
prudent and successful practitioner; not because of great learning or 
extensive acquaintance with medical literature, although he was a well- 
read physician, but more particularly on account of familiarity with 
practical therapeutic knowledge. His conservatism led him to attent- 
ively study the practical uses of the more common methods, rather 
then experiment with new and untried measures. In his medical 
studies he discarded theoretical and visionary questions, and confined 
his researches to those methods having a practical bearing upon the 
cases he was called upon to treat. He was firm in his convictions, but 
was not demonstrative. He was not a visionary enthusiast. Life was 
a reality with him. He loved its duties, responsibilities, and even its 
sacrifices, and cheerfully endeavored to conscientiously perform his 
part with fidelity and zeal. 

His genial and modest bearing, his kind and unassuming manner, 
his steadiness of purpose, his untiring devotion to the welfare of his 
patients, his family and the community in which he lived, are traits of 
a well-rounded character to which his daily life gave practical illustra- 

After alluding to the fact that this was the fourth time since the 
society was organized that it had been called upon to take action rela- 
ting to the death of one of its members, Dr. Gorham said : " The sud- 
den removal from labor to rest of our lamented friend, Dr. Randel, 
brings again vividly to memory the loss of our valued associate, Dr. 
Delavan. Taken without warning, as they were, while in the midst of 
life's activities, their good deeds constituting the essence of usefulness 
to others, we sincerely mourn their death while we bow to the will of 
the Infinite. I had not the pleasure of an intimate acquaintance with 
Dr. Randel. When, however, I have met him I have been impressed 
with his hearty good cheer, gentlemanly courtesy and earnest devotion 
to professional work." 

Eulogistic remarks were also made by Drs. Cox and Jones. 

196 Department of Necrology. 

The following resolutions of respect were then adopted by the 
society : 


Resolved, That the members of the Albany County Homoeopathic 
Medical Society have learned with profound sorrow and regret of the 
death of William H. Randel, M. D., a valued and honored member. 

Resolved, That we hereby express our great sense of loss and grief 
in the death of our colleague, and record the sincere regard in which 
he was held by his medical associates. 

Resolved, That by his sudden and untimely death we have lost a 
genial and highly esteemed member, the profession a valued and faith- 
ful worker and the people whom he served a friend, whose cheering 
words and wise counsels will be long remembered. 

Resolved, That in this deep affliction we extend our fullest sympa- 
thies to his sorrow-stricken family. 

Resolved, That a copy of these resolutions be spread upon the minntes 
of this society and a copy be presented to the family of the deceased. 


TROT, N. Y. 

Charles G. Clark, M. D., one of the most prominent homoeopathists 
of Troy, N. Y., was born in that city May 15, 1841. He was the oldest 
son of Mr. and Mrs. Otis G. Clark. He was prepared for college at 
Essex, Conn., and graduated from Union College in 1863, having dur- 
ing his collegiate career, carried off the prize for the Greek oration. 
He determined to pursue the profession of medicine, and graduated 
from Ann Arbor, Mich., and afterwards continued his studies and 
practice at Belle vue Hospital, New York. In 1866 he began practice 
in Troy. The same year he married Miss L. Addie Johnson, of that 
city, who, with one son, Charles J. Clark, a student at Rochester Uni- 
versity, survives him. At the time of his death he had a large prac- 
tice and was considered one of the city's most skilled, successful and 
able physicians. 

Dr. Clark was a Republican in his politics and presided as Chair- 
man of local conventions on one or two occasions. He was elected 
alderman in the third ward of his native city in 1880, and served one 
term of two years. He was one of the first members of the Board 
of Education, under the present law of Troy, being on the Board dur- 
ing the years 1872, 1873 and 1874. 

During the evening of December 13, 1887, friends called on him at 
his residence, No. 84 Fourth street, where he visited with them, chat- 

• I ■. "**»*L 

Department of Necrology. 197 


ing and laughing in a cheery manner. About ten o'clock they left the 
house and soon afterward he was called to attend a patient at 83 
Fourth street, nearly opposite his office. While there he became sud- , :•• || 
denly faint, but thinking his sickness but temporary, he prescribed for 
himself and laid down on a lounge to rest. Instead of becoming bet- 
ter he steadily grew worse, and Drs. Richard Bloss and R. B. Boute- 
cue were sent for. All that medical skill could think of was done for 
him, but after lingering until one o'clock on the morning of the 14th, 
he expired. He was an athletic and robust man, apparently the pict- 
ure of health. He had been complaining for some time, however, of a 
rheumatic difficulty, but neither he nor his family considered it at all 
dangerous. An autopsy wa» held, at which Drs. R. B. Bontecue, R. & 
J. B. Bloss, William Seymour, W. Akin and J. W. Morris were pres* 
ent, and the cause of his death was found to be congestion of the 
lungs complicated with heart failure. 

His funeral was attended from the Fifth Avenue Baptist Church, of 
which he was a member, the Revs. H. O. Hiscock, C. P. Sheldon, 
D. D., and J. H. Griffith, D. D., of Buffalo, officiating. The pall- 
bearers were Drs. H. E. Fuller, M. W. Campbell, R. B. Bontecue, 
M. H. Burton and Messrs. H. W. Gordinier and W. A. Sherman. 
The attendance at the church was so large that it was impossible to 
furnish seats for all and many stood in the aisles. 

Dr. Clark was a gentleman of genial ways and of generous heart. 
Of his success as a physician we have already spoken. Whatever the 
public positions he held their duties were discharged with fidelity and 
credit. The following resolutions were unanimously adopted at a 
special meeting of the Rensselaer County Homoeopathic Society, held 
Thursday, December 15th : 

Resolved, That the members of the Rensselaer County Homoeo- 
pathic Medical Society have learned with deepest sorrow and regret of 
the sudden death of Dr. C. G. Clark, one of its most devoted and 
earnest supporters. 

Resolved, That we hereby signify the sense of the great loss which 
we have sustained in the deatn of our esteemed colleague and give 
expression to the high appreciation of his valued services to the medi- 
cal profession, of wnich he was an honored and useful member, and 
to the homoeopathic school, of which he was an able and distinguished 

Resolved, That in this afflictive dispensation we have been deprived 
of a member whose quick perceptions, sound and reliable suggestions 
and rich experience rendered him a safe and valued associate ; and the 
sick and suffering a friend and counselor whose benignant presence 
will not be readily replaced or supplied. 

198 Department of Necrology. 

Resolved, That while his sterling good sense, his manly and generous 
impulses, his affable, genial and social qualities of heart and mind 
endeared him to the public, he was also held in high esteem by his 
medical associates on account of his careful regard for the courtesies 
and amenities of professional fellowship. 

Resolved, That a copy of these resolutions be entered on the records 
of this society, transmitted to the family of the deceased and pub- 
lished in the daily papers. 

Hiram E. Fuller, M. D., Secretary. 



Biographical Sketch of 

Horace marshfield Paine, a. m. m. d. 

Dr. Horace M. Paine, of Albany, N. Y., was born at Paris, Oneida 
County, N. Y., November 19, 1827. He is the eldest son of the late 
Dr. John A. Paine, and is the only brother of Professor John A. Paine, 
of Tarrytown, N. Y. 

Dr. Paine received an academical education at Newark, N. J., under 
the supervision of his uncle, the late William R. Weeks, D. D., as his 
father had thirty years previously; pursued the study of medicine 
under the direction of his father, and was graduated from the medical 
department of the University of the City of New York, March 11, 
1859. He received the honorary degree of Master of Arts from Ham- 
ilton College in June, 1860, and also the honorary degree of Doctor of 
Medicine, on recommendation of the Homoeopathic Medical Society of 
the State of New York, in July, 1881. 

He began practice in Albany in the spring of 1849 ; remained until 
August, 1855, when he removed to Clinton, Oneida County, N. Y., 
where he resided ten years, returning in 1865 to Albany, his present 
(1888) residence, where he is engaged in consultation and general 
practice, giving attention more particularly to the treatment of non- 
surgical uterine diseases. Prior to the year 1849, the accessions to the 
ranks of homoeopathic practitioners were from among those who had 
been previously engaged for several years in old-school practice. Dr. 
Paine was the first young physician who began the practice of homoe- 
opathy at Albany immediately after graduation. 

Dr. Paine adopted the homoeopathic system of practice at the begin- 
ning of his professional life, and adheres to it chiefly. By the term of 
u homoeopathic system of practice" he intends to embrace only the 
principle of similars. He rejects the doctrine of the minimum dose, 
using the words small dose preferably, as less misleading and less 
likely to prove harmful to correct homoeopathic principles. He believes 
Hahnemann's theories to be visionary and unphilosopical regarding the 
origin of chronic diseases and the dynamization (spiritualizing) of drugs, 
whereby a largely increased curative force is supposed to be developed 
by a process of agitation long after the medicinal substance in a mate- 

* v 


200 Biographical Sketch. 

rial form has ceased to exist. He believes that the only curative force 
thus imparted (if any really exist), is merely a development of well- 
known magnetic or psychological influences which are being constantly 
and successfully applied, with even more prompt and remarkable 
results, than are claimed for the use of dynamized homoeopathic 

Having joined the homoeopathic school while still in its infancy he 
shared with his associates the ostracism and professional seclusion mani- 
fested by old-school opponents. The bitterness of feeling on the part 
of the old-school, which at that time was almost universal, incited 
many of the more prominent homoeopathists in New York State to 
unite in instituting measures for obtaining, in behalf of themselves and 
their colleagues, such legal recognition as would give them an honorable 
and reputable standing before the public. After many trials, repeated 
failures and years of patient, persistent effort, those who early entered 
upon the work of securing an equal legal status with that of the old- 
school were finally gratified by the erection of a distinct school of 
medicine, and as such, recognized by the laws of the State. 

The establishment of this distinct school, on account of the compari- 
son before the public of the two rival systems continually being made, 
has largely contributed to the marked change in the old-school system 
of treatment, and has forced its practitioners to observe, more clearly 
than ever before, the exact natural relationship between diseases and rem- 
edies, and hence to become more accurate and more successful physicians. 

Dr. Paine early became an active participant in these reformatory 
measures. To such an extent is this true that a full description of his 
efforts in connection with the* polemics of homoeopathy would consti- 
tute a tolerably complete record of the homoeopathic school during 
twenty years of its history in this State. 

On his retirement from the secretaryship of the New York State 
Homoeopathic Medical Society, suitable testimonials were presented 
him, setting forth the character and results of his efforts for the per- 
manent establishment of the homoeopathic school on a legal and 
political basis equal to that of the allopathic. A full report of the pro- 
ceedings had in connection with the presentation of these testimonials 
is published in the tenth volume of the Transactions of the Homoe- 
opathic Medical Society of the State of New York. They are not only 
complimentary to those who were the active participants in the work, 
but also constitute a chapter in the early experience of the homoeop- 
athic school of special significance and interest. 

Biographical Sketch. 201 

Through these persistent and well directed efforts, and those of 
equally zealous and successful colleagues in other states, our present 
honorable position has been attained, and the prestige and influence of 
the homoeopathic school, which represents advanced, sound and dis- 
tinctive principles, has been finally secured. 

Soon after the legal separation of the rivals, it became manifest that 
the members of the old-school were endeavoring to convey the impres- 
sion that homoeopathists were not educated in any except their own sys- 
tem, and on that account were not competent or trustworthy physicians. 
This impression gained credence in some localities to such an extent 
that the sectarian name homceapathist came to have a restricted and 
illiberal meaning, and to denote one who, by education and practice, 
was a believer in and practitioner of a single dogma, and not & physi- 
cian in the broadest and most liberal use of the term. 

In order to assist in correcting this false impression, for a number of 
years prior to 1880, Dr. Paine advocated the disuse of the sectarian 
name, and endeavored to promote all measures having, for their object 
the union of all qualified medical men on a liberal foundation without 
regard to therapeutic belief. During that year, however, the Homoe- 
opathic Medical Society of the State pf New York adopted a declara- 
tion stating substantially that while homoeopathists believed in and 
endeavored to apply the principle of similars, and considered it pref- 
erable to any other method extant in a large percentage of cases, they 
admitted the occasional curative value of remedies other than homoe- 
opathic, and held themselves ready to use any and all measures 
required by the exigencies of any case under treatment. 

Since the formal adoption of the foregoing declaration, Dr. Paine 
has not advocated a disuse of the distinctive name, on the ground that, 
being properly defined and qualified, its use could not reasonably there- 
after be made applicable in an objectional sense, its reference being 
thereby limited to a rational system of treatment rather than a class of 
physicians ; in fact, in order to intelligently distinguish between 
opposing therapeutic systems, a specific name seems indispensable. 

In the department of drug proving, as required by the homoeopathic 
system, Dr. Paine has contributed several thorough and serviceable 
trials, notably provings of Rumex crispus (yellow dock), Aesculus 
hippocastanum (horse-chestnut), and Cimicifuga (actea) Eacemosa 
(black cohosh). He has also invented new forms of syringes for apply- 
ing soft cerates in intra-uterine treatment, also several new forms of 
pessaries and uterine supporters ; also new and improved apparatus for 


the prolonged application of hot crater in the treatment of uterine and 
pelvic diseases ; he also demonstrated the utility of Carbonate and 
Iodide of Lime in the treatment of scirrhus of the breast and uterine 

He has contributed upwards of fifty articles for publication in cur- 
rent medical journals and in the Transactions of the Horuceopnthie 
Medical Society of the State of New York. The more important 
subjects treated in the3e essays may be classed under the following 
heads : Rare and Important Clinical Cases ; Drug Proving ; Hygiene ; 
Medical Education ; Registration of Prevailing Diseases ; Superiority 
of Homoeopathic Treatment ; Danger to Homoeopathy from Erroneous 
and Unphilosophical Theories; Freedom of Medical Opinion and 
Action ; Medical Legislation ; and the Legal Status, Organization and 
Progress of Homoeopathy. 

The more important offices and appointments held by Dr. Paine are 
the following : 

Became a member of the American Institute of Homoeopathy in 
1850, and a senior member thereof in 1875, its provisional Secretary 
one year in 1867, and Secretary of the Association of Seniors in 1884. 

He was present and became a member of the Homoeopathic Medi- 
cal Society of the State of New York at its organization in 1850, 
became a permanent member in 1864, was elected its Secretary in 
1S59, and held that office, with the exception of one year, until 1873, 
and was elected to the presidency of the society in 1887. 

He was present and became a member of the Oneida County 
Homoeopathic Medical Society at its organization in 1857, and retained 
membership therein until 1865, was elected its Secretary in 1858, and 
held the office seven years. 

Became a member of the Albany County Homoeopathic Medical 
Society in 1865, its Secretary from 1865 to 1870, and its President in 

1874 and 1887. 

Became a member of the Medical Society of Northern New York 
in 1865, was elected its President in 1870, and its Secretary in 1880, 
serving five years. 

Was appointed Medical Director of the Atlantic Mutual Life Insur- 
ance Company in 1866, at its organization, and held the office eleven 
years, during the whole period of its existence. 

Was elected to membership in the Board of Trustees of the Albany 
City Homoeopathic Dispensary at its organization in 1868, and of the 

Biookaphioal Sketch. 203 

Homoeopathic Hospital in 1872 ; also a member of the Medical Staff 
and Executive Committee since 1868. 

Was appointed in 1871 by the Homoeopathic Medical Society of the 
State of New York, a member of a special committee, in conjunction 
with similar committees of other State Homoeopathic Medical Socie- 
ties to visit President U. S. Grant at Washington, for the purpose of 
protesting against the unjust action of Dr. H. Van Aernain, Commis- 
sioner of Pensions, for having attempted the establishment of sectari- 
anism in medicine by the removal of homoeopathic pension surgeons. 
The reason given by Dr. Van Aernam being that they belonged to a 
school of medicine which " was n-ot recognized by the government" 
(Dr. Van Aernam was dismissed a few weeks thereafter). 

Became a member of the first State Board of Medical Examiners 
appointed by the Regents of the University of the State of New York 
at its organization in 1872, and still (1888) retains membership therein y 
was elected its Secretary in 1873, and held the office four years. 

Became a member of the Board of Trustees of the New York State 
Homoeopathic Asylum for the Insane, at Middletown, Orange County, 
in 1872, and remained in office seven years. 

Was appointed associate editor of The Medical Union, a monthly 
medical journal published in New York *city, in 1873, and held the 
appointment one year. 

Became physician to the Albany House of Shelter, a reformatory 
institution, in 1877, and still (1888) holds the position. 

He has been elected to honorary membership in the State Medical 
Societies of California, Connecticut, Illinois, Massachusetts and Penn- 
sylvania; the Central Homoeopathic Medical Society of Germany; 
the Imperial Homoeopathic Medical Society of St. Petersburg, Russia, 
and several other institutions and county medical societies. 

Dr. Paine' s ancestors are traced back through nine generations, the 
original members having emigrated from England in 1651 or 52, and 
settled first at Salem, afterward at Dedham, Mass., and finally at South- 
old, Long Island. 

He married Charlotte Mann, daughter of Salmon Mann, Esq., in 
1852. He has three sons and one daughter. Residence (1888) Albany, 
N. Y. 

Nathaniel Emmons Paine, A. M., M. D., Hamilton College, class of 
1879, Albany Medical College 1875, Superintendent of the Westboro 
Insane Hospital, Westboro, Mass. 

204 Biographical Sketch. , 

Howard Simmons Paine, A. M., M. D., Hamilton College, class of 
1878, Albany Medical College, 1881. Engaged in general practice at 
Albany, K Y. 

Clarence Mann Paine, A. M., M. D., Hamilton College, class of 
1884, Albany Medical College, 1887. Engaged in general practice at 
Albany, N. Y. 

Emily Florence Paine was graduated from Mount Holyoke Semi- 
nary, class of 1886. 






State of New York. 


Article I. 

Name and Object. — This association shall be known as the Homoe- 
opathic Medical Society of the State of New York, and its object shall 
be the advancement of medical science. 

Article II. 

Laws of the State Deemed a Part of the Constitution. — -The laws of 
the State of New York, regulating the practice of medicine and surgery 
shall be deemed a part of this constitution. 

Article III. 

Officers. — When and How to be Elected. — The officers of this 
Society shall be a president, three vice-presidents, secretary and treas- 
urer ; all of whom shall be elected by ballot at an annual meeting. 

Election of Censors. — The Society shall also, at an annual meeting, 
elect twelve censors, any three of whom shall constitute a quorum. 

Majority Vote Necessary to a Choice and Term of Office. — At all 
elections of officers the votes of a majority of the members present shall 
be necessary to a choice ; their term of office shall commence at the 
adjournment of the meeting at which they were elected, and shall con- 
tinue for one year, or until the close of the annual meeting next suc- 
ceeding the one at which they were elected, and until others are chosen 
in their places. 

Article IV. 

Duties of Officers. — The duties of the officers shall be such as are 
prescribed by the laws of the State, and in addition thereto, such as 
may be from time to time designated by the by-laws. 

206 Constitution and Bp~Laws. 

Article V. 

How Constituted. — The Society shall be composed of delegates from 
each county homoeopathic medical society and horpoeopathic medical 
college in this State, and such other members as may be designated in 
the by-laws. 

Article VI. 

Annual Meeting. — The annual meeting of the Society shall be held 
in the city of Albany, commencing on the second Tuesday in February 
of each year. 

Article VII. 

Quorum — At any meeting of the Society seven members shall con- 
stitute a quorum. 

Article VIII. 

Seal. — The Society may have a common seal with a suitable device 
and inscription. 

Article IX. 

Amendments. — This constitution may be altered or amended by a 
two-thirds vote of the members present, provided that notice of such 
alteration or amendment shall have been given in writing at the pre- 
vious annual meeting. 


Section 1. 

Duties of the President. — The president shall preside at the meet- 
ings of the Society, preserve order therein, put all questions, announce 
the decisions, appoint committees not otherwise ordered ; receive and 
pay over to the treasurer the sum of ten dollars for each diploma 
granted by the Society ; direct the secretary to call extra meetings on 
the written request of any seven members explaining the reason for 
such action ; deliver an address at the annual or semi-annual meeting, 
or procure a substitute, and perform such other duties pertaining to 
his office as may be required of him by the Society. 

Section 2. 

Duties of the Vice-Presidents. — It shall be the duty of the vice-presi- 
dents, in the order of their election, to perform, in the absence of the 
president, the duties of that officer. 

Constitution and By-Laws. 207 

Section 3. 

Duties of the Secretary. — It shall be the duty of the secretary to 
provide a book in which he shall make an entry of all resolutions and 
proceedings which may be had from time to time ; also the name of 
each and every member of said Society, and the time of his admission ; 
preserve all documents belonging to the Society ; divide the delegates 
into four classes in compliance with section nine of these by-laws ; give 
notice of all meetings and deliver to his successor in office all books 
and papers belonging to the Society. 

Section 4. 

Correspondence. — It shall be the duty of the secretary to receive and 
lay before the Society all communications addressed to it, and gener- 
ally to conduct the correspondence of the Society ; notifying bureaux 
and committees of their appointment ; notify the secretaries of the 
respective county societies whenever there are vacancies in the list of 
delegates, and perform such other duties pertaining to his office as, by 
vote of the Society, may devolve upon him. 

Section 5. 

Duties of the Treasurer. — The treasurer shall receive and be 
accountable for all moneys belonging to the Society, pay out, on the 
warrant of the president, such sums as may be agreed upon at the 
annual meeting, and report in writing at each annual meeting. 

Section 6. 

Duties of Censors. — It shall be the duty of the censors to examine 
carefully the credentials of all applicants for membership that may be 
referred to them, and determine whether the applicant has proper quali- 
fications for permanent membership in the Society, the votes of a 
majority of the members of the board of censors present at an annual 
or semi-annual meeting being a prerequisite to the election of a can- 

Section 7. 

Executive Board. — The president, vice-presidents, secretary and 
treasurer shall constitute the executive board, whose duty shall be to 
make arrangements for the meeting of the Society, arrange the busi- 
ness of the sessions, attend to matters of business not otherwise specially 
provided for, and perform such other duties as .may, by vote of the 
Society, devolve upon it. This board shall also constitute the advisory 
committee of publication, to whom shall be referred all papers, the 
publication of which is deemed by the secretary and chiefs of bureaux 
of doubtful expediency. 


208 Constitution and By-Laws. 

Section 8. — Bureaux and Committees. 

Materia Medica. — There shall be a bureau of materia medica and 
provingg, which shall obtain facts relating to the materia medica and 
institute and collect and arrange provings of the drugs. There shall 
be, in connection with this bureau, a department of pharmacy. 

Clinical Medicine — There shall be a bureau of clinical medicine, 
which shall collect facts relating to clinical medicine generally, and spec- 
ially to any epidemic or endemic diseases which may exist in the State. 

Obstetrics. — There shall be a bureau of obstetrics, which shall collect 
and report to the Society facts and observations on subjects pertaining 

Surgery. — There shall be a bureau of surgery, which shall report all 
improvements in surgery. 

Mental and Nervous Diseases. — There shall be a bureau of mental 
and nervous diseases, which shall collect and report facts relating espec- 
ially to 6uch diseases. 

Gynaecology. — There shall be a bureau of gynaecology, which shall 
report to the Society all items of importance in that department of 
medical science. 

Pcedology. — There shall be a bureau of paedology, which shall report 
facts and deductions in treatment of diseases of children. 

Ophthalmology. — There shall be a bureau of opthalmology, which 
shall report all improvements in that branch of science 

Histology. — There shall be a bureau of histology, which shall report 
facts in histology. 

Climatology. — There shall be a bureau of climatology, which shall 
report on the climate of different localities, and the influence of climate 
on health and disease. 

Vital Statistics. — There shall be a bureau of vital statistics, which 
shall report all items of comparative mortality and such other facts as 
pertain to the subject. 

Medical Education. — There shall be a committee on medical educa- 
tion, which shall report all progress in the elevation of the standard of 

Societies and Institutions. — There shall be a committee of societies 
and institutions, which shall keep a register of all homoeopathic physi- 
cians in the State, prepare a list of socities and organizations, and col- 
lect statistics regarding the status and progress of homoeopathy. 
There shall be in connection with this committee a department of 

Constitution and By-Laws. 209 

Appointment. — Each of these bureaux and committees shall consist 

of as many members as the president shall see fit to appoint — not less 

than three — who, with the exception of the chairman, shall be 

' appointed annually by the president, with the advice of the other 

members of the executive board. 

Chairmen of similar bureaux in county societies shall be, eu>-ojficio, 
corresponding members of these bureaux. 

Finance Committee. — There shall be a finance committee, which 
shall consist of the treasurer of the Society, ex-ojficio, and two mem- 
bers, to be appointed annually by the president, the same as members 
of other committees are appointed. No officer or committee of the 
Society shall be authorized to expend any money of the Society, or 
incur any debt in the name of the Society, without the consent of a 
majority of this committee. No resolution, calling for the expending 
of any money, shall be presented to the Society for its approval, till it 
has received the approval of a majority of this committee. 

Section 9. — Membership. 

Delegates from County Societies. — Each county homoeopathic medi- 
eal society in this State is entitled to elect as many delegates to this 
Society as there are members of assembly to their respective counties. 

Delegates from Institutions. — Each homoeopathic medical college, 
hospital, asylum, dispensary, board of medical examiners, or other cor- 
porate homoeopathic institution or association, shall be entitled to single 
delegate representation in this Society, upon payment of the same dues 
as other delegates. 

Classification of Delegates. — Delegates to this Society shall be 
divided into four classes, one of which shall go out of office annually ; 
and it is hereby made the duty of the secretary to so classify them as 
to keep the number as nearly equal as possible. 

Permanent Members. — Any legally qualified physician may be 
elected a member of this Society upon written recommendation of 
three permanent members. Nominations shall be received at an annual 
or semi-annual meeting, and being referred to the censors, shall come 
up at an annual meeting. Those physicians recommended by the 
board of censors shall be balloted for, and all who receive a majority 
of the votes of those present shall be declared elected. When the 
application is presented, the candidate shall sign the following state- 
ment : I request membership in the Homoeopathic Medical Society of 
the State of New York, and I agree, if elected, to pay my annual dues 

to the Society. I hereby acknowledge that I believe in the law 
Similia Similibus (Jurantur. 

210 Constitution and By-Laws. 

Privileges. — Persons so elected shall be entitled to all the privileges 
of membership. 

Honorary Members. — The Society may elect honorary members, 
non-resident of this State, not to exceed six in number in any one year, 
the names of such persons having been presented at least one year pre- 
vious to their election. Before election reasons shall be stated to the 
Society for conferring the honor. 

Privileges. — Honorary members shall not be entitled to vote at the 
meetings of the Society, or be subject to taxation. 

Senior Members. — Any permanent member over sixty-five years of 
age may be elected a senior member of this Society at any annual 
meeting, provided that at the time of said election he or she shall have 
been a permanent member for the previous twenty years, and is at the 
time of his or her election in good standing in the Society. 

Privileges. — Persons so elected shall be entitled to all the privileges 
of membership, and shall be exempt from taxation and dues. 

Regmttf Degree. — The Society may annually recommend the names 
of four persons to the Regents of the University for the honorary 
degree of doctor of medicine, provided that the person so recom- 
mended shall possess good moral and professional standing, shall have 
attained the age of forty-five years, and shall have received the votes 
of not less than two-thirds of the members present at any annual meet- 
ing. The mode of nomination shall be as follows : Names shall be 
presented in open nomination, and be referred to a committee appointed 
for the purpose, which shall report after the election of officers ; the 
number to be voted for at one ballot shall not exceed four, and 
the names of those only who shall have received the .votes of two- 
thirds of the members present shall be presented. 

Section 10. 

Dues. — The dues' from each permanent member shall be five dollars 
for the first year, which shall include the certificate of membership, 
and three dollars for each subsequent year. From each county society 
there shall be due three dollars for each delegate to which the society 
is entitled, and from each institution which sends a delegate. 

All dues shall be declared due, and payment of the same to the treas- 
urer of the society required, within thirty days succeeding the annual 

Any members in arrears shall not be entitled to the privileges of 

Any member five years in arrears shall be dropped from the roll and 
not be eligible for re-election until all arrearages are paid. 

Constitution and By-Laws. 211 

Each permanent member not in arrears for does shall be furnished 
with one copy of the Transactions of the Society without further cost, 
and each county society with as many copies as it pays " fees " for 

Section 11. 

Duties of Secretaries of County Societies. — The secretary of each 
county homoeopathic medical society in this State is requested to fur- 
nish the secretary of this Society, on or before the first day of January 
of each year, a report consisting of : — 

1. A list of officers and members of his county society with their 
addresses in full. 

2. Biographical notices of any who have died during the previous 

3. The time of holding annual and regular meetings, together with 
a list of all medical committees and a complete copy of the proceed- 
ings of each meeting. 

4. A copy of all reports of general interest, also copies of addresses 
and communications on subjects relating to medical science. 

Section 12. 

Nominations. — At each annual meeting the nomination of the offi- 
cers of the society, chairman of bureaux, delegates to other societies 
and honorary members shall be made openly, except when referred to 
a committee on nominations to be appointed for that purpose. With 
each nomination for honorary membership the reason for conferring 
the honor shall be stated to the Society. 

Section 13. 

Communications ; their publication. — Communications read before 
the Society become its property to be deposited in its archieves ; but no 
paper shall be published as a part of the Transactions without the 
approval of a majority of the committee on publication, unless the 
same be ordered by a vote of the Society. 

Section 14. 

Order of Business. — At the meetings of the Society the following 
shall be the regular order of business : 
First day. 1. Communication from the president. 

2. Reading of the minutes of the last meeting. 

3. Report of the committee on credentials. 

4. Election of officers, chairman of bureaux, delegates to other 
societies, permanent and honorary members previously nominated. 

212 Constitution and By-Laws. 

5. Report of the treasurer, and the auditing of his accounts. 

No other business 6hall be considered by the Society until the fore- 
going items are disposed of, when subjects of a miscellaneous character 
may be entered upon. 

6. Report of medical committees. 

7. Presentation of reports and communications on medical and sur- 
gical subjects. 

Section 15. 

Amendments. — These by-laws may be altered or amended at any 
regular meeting by the vote of two-thirds of the members present. 

Deceased Permanent Members. 


3n ADemorf am* 


Yew of 


86.'> P. W. Gray, 

866 W. G. Wolcott, 

865 E. A. Potter, 

868 M. M. Matthews, - 

869 A. Cooke Hull,- - 

863 H. S. Benedict, 

867 Edgat B. Cole, - 

871 A Win Shattuck, - 

866 John Sarles, 
M6 Albert Wright, 

869 E. P. K. Smith, - 

870 Henry E. Morrill, - 

872 Nathan Spencer, - 
866 Benjamin F. Bowers, 
872 Win. Baxter, A. M., - 

872 James Cromwell, 

864 S. B. Barlow, 

866 Lyman Clary, - 
870 Hylon Doty, 
875 Geo. F. Hurd, 

865 Carroll Dunham, A. M., 

873 Wm. J. Bryan, - 

874 Henry Sales, 
864 Daniel D. Smith, 

867 Franklin F. Hunt, - 
863 Erastus A. Munger, 

869 Stephen D. Hand, - 

870 L. B. Waldo, A. M., - 

871 H. V. Miller, A. M., 
873 J. M. Cadmus, - 

868 H. F. Adams, 
868 Alfred H. Beers, 
879 E. B. Squires, - 
864, William Wright, 

Afire. Date of Death. 

59, Dec. 18, 1865, 
50, Sept. 7, 1866, 
61, July 29, 1867, 
58, Nov. 23, 1867, 

50, July 3, 1868, 
46, Oct. 18, 1869, 
45, Nov. 10, 1871, 
52, Aug.13, 1872, 

Nov. 7, 1873, 
70, Dec. 1874, 

57, Dec. 27, 1874, 
61, Mar. 6, 1874, 
65, Dec. 17, 1874, 
79, Feb. 1875, 

70, July 3, 1875, 

64, Dec. 7, 1875, 
78, Feb. 27, 1876, 
74, June 1, 1876, 

58, May 5, 1876, 
26, Sep. 29, 1876, 
.49, Feb. 18, 1877, 
39, July 13, 1877, 

65, Mar. 8, 1877, 

71, Mar. 7, 1878, 
68, Oct. 20, 1878, 

66, Nov. 4,1879, 

72, Mar. 10, 1879, 
•64, July 9,1879, 

51, Nov. 26, 1879, 
45, May 10,1879, 

41, Jan. 12, 1869, 
29, May 7, 1879, 
74, Sep. 23, 1880, 














W. Windfield. 

New York. 

Wappinger's Falls. 

Lake George. 

New York. 








New York. 



West Troy. 








Deceased Permanent Members. 


Station. Name. 

1866 Marcellii8 M. Gardner, - 

1867 A. C. Burke, A. M., m - 
1867 Garret D. Crispell, - 
1874 Benjamin Lansing, 
1880 Warren Freeman, - 
1863 Benjamin F. Cornell, - 

1865 E. T. Kichardson, - 
1872 W. B. Stebbins, - 

1866 Jno. F. Gray, LL. D., 

1874 Albert E. Sumner, A. M. 
1880 Win. Scherzer, 

1 867 Augustus Pool, - 

1868 B. B Schenck, 

1868 Harmon Swits, - 

1869 C H. Carpenter, - 

1872 George W. Peer, 

1878 C. E. Blumenthal, LL D. 

1880 Wm. H. Van Derzee, - 

1863 Abijah P. Cook, - 

1879 L. W. Flagg, 

1870 F. W. Ingalls, 

1871 John Savage Delavan - 
1877 Augustus C. Hoxsie, 
1882 Theophilus W. Kead, 
1868 Benjamin F. Joslin, 

1864 David F. Bishop, 
1871 Thos. J. Pettit, 
1871 Cornelius Ormes, 

1877 C. M. Lawrence,* - 

1878 Carl Th. Liebold,* 
1863 Titus L. Brown,* - 

1881 Jacob S. Philip, - 

1875 Arthur P. Hollett, - 
1866 L. M. Kenyon, - 

1873 Wm. Henry Eandell. 
1870 Chas> G. dark, - 

Age. Date of Death. 

49, July 31, 1880, 

62, Apr. 15, 1880, 

75, Dec. 15, 1880, 
Sep. 21, 1880, 

65, April 5, 1880, 

76, May 12, 1881, 
67, Aug. 14, 1881, 
74, Nov 4, 1881, 

. 78, June, 6, 1882, 

, 42, Aug.31, 1882, 

57, Feb. 21, 1882, 

65, Aug. 9, 1883, 

74, Mar. 22, 1883, 

64, June 25, 1883, 
■ 58, Sep. 23, 1883, 

63, Jan. 12, 1883, 
, 69, Oct. 11, 1883, 

26, Aug. 29, 1883, 

- 76, Sep. 23, 1884, 


Feb. 15, 1885, 
44, Aug. 7, 1885, 

- 47, May 23, 1885, 

65, Nov. 17, 1885, 

- 55, Apr. 18, 1885, 
57, Apr 24, 1885, 

- 69, Mar. 3, 1886, 
79, Apr. 20, 1886, 

Sep. 30, 1886, 

Nov. 30, 1886, 

Aug. 17, 1887, 

63, Apr. 25, 1887, 

- 40, Sep. 29, 1887, 

66, STov. 25, 1887, 

- 55, Dec. 14, 1887, 
46, Dec. 14, 1887, 






New York. 

Fort Edwards. * 


Little Falls. 

New York. 


New York. 


Plain ville. 




New York. 







Big Flats. 

Montclair. N. J. 


Fort Plain. 


Port Jervis. 

New York. 







♦Biographical sketches of Drs. Lawrence, Liebold and Brown will appear in next Volume of 




Honorary, Senior, Permanent 



List of Officers. 





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218 Honoraby Members. 



Constantine Hering, M. D., Philadelphia, Penn. 

I.T. Talbot, M. D., Boston, Mass. 

E. C. Witherill, M. D., Cincinnati, Ohio. 


*Gaylord D. Beebe, M. D., Chicago, 111, 
Edwin M. Hale, M. D., Chicago, 111. 
*A. H. Oakley, M. D., Providence, E. I. 
John C. Sanders, M. D., Cleveland, Ohio. 
David Wilson, M. D., London, England. 


*Elial T. Foote, M. D., New Haven, Conn. 
*Samuel Gregg, M. D., Boston, Mass. 
Charles T. Harris, M. D., Syracuse, N. T. 
*Wm. E. Payne, M. D., Bath, Me. 
Francis Sims, M. D., Philadelphia, Penn. 
David S. Smith, M. D., Chicago, 111. 


*Walter Williamson, M. D., Philadelphia, Penn. 
*Ira Barrows, M. D., Providence, R. I. 
Robert E. Dudgeon, M. D., London, England. 
*E. C. Franklin, M. D., St. Louis, Mo. 
Wm. L. Jackson, M. D., Boston, Mass. 
Alvin E. Small, M. D., Chicago, 111. 


Charles Cropper, M. D., Lebanon, Ohio. 
Charles Cullis, M. D., Boston, Mass. 

Edwin R. Heath, M. D., , Kansas. 

William H. Holcomb, M. D., New Orleans, La. 
Bushrod W. James, M. D., Philadelphia, Penn. 


*William Bayes, M. D., London, England. 
T. C. Duncan, M. D., Chicago, 111. 
Win. Henderson, M. D., Edinburgh, Scotland. 
John C. Morgan, M. D., Philadelphia, Penn. 


Honorajry Members. 219 


John Drummond, M. D., Manchester, England. 
John J. Drysdale, M. D., Liverpool, England. 
John J. Edie, M. D., Leavenworth, Kansas. 
*Dr. v Grauvogl, Munich, Bavaria. 
H. R. Madden, M. D., London, England. 
D. G. Woodvine, M. D., Boston, Mass. 


C. Hempel, M. D., St. Petersburg, Russia. 

B. Hirshel, M. D., Dresden, Saxony. 

Alfred C. Pope, M. D., Lee, England. 

Mathias Roth, M. D., London, England. 

*Robert J. McClatchey, M. D., Philadelphia, Penn. 


0. G. McKnight, M. D., Providence, R. I. 
*W. W. Rodman, M. D., New Haven, Conn. 



*E. H. Ruddock, M. D., London, England. 
L. de V. Wilder, M. D., Hartford, Conn. 

F. B. Mandeville, M. D., Newark, N. J. 
Samuel Worcester, M. D., Salern, Mass. 


*Leverett Bishop, M. D., Sauquoit, N. Y. 
R. Ludlam, M. D., Chicago,' 111. 


G. E. E. Sparhawk, M. D., Burlington, Vt. 


*G. W. Swazy, M. D., Springfield, Mass. 
*J. H. Pulte, M. D., Cincinnati, Ohio. 

Thomas Skinner, M. D., London, England. 


E. G. Cook, M. D., Chicago, 111. 

H. A. Houghton, M. D., Charlestown, Mass. 

220 Honoeaky Members. 


E. A. Guilbert, M. D., Dubuque, Iowa. 

H. N. Guernsey, M. D., Philadelphia, Penn. 


J. P. Dake, M. D., Nashville, Tenn. 
W. L. Breyfogle, M. D., Louisville, Ky. 
Samuel Potter, M. D., Milwaukee, Wis. 
F. s F. DeDerkey, M. D., Sacramento, Cal. 
John C. Budlong, M. D., Providence, R. I. 
J. H. Gallinger, M. D., Concord, N. H. 


*R. E. Caruthers, M. D., Allegheny, Penn. 
John M. Hayward, M. D., Liverpool, Eugland. 
J. Giles Blake, England. 
Samuel A. Jones, M. D., Ann Arbor, Mich. 
George B. Peck, M. D., Providence, R. I. 
O. S. Runnels, M. D., Indianapolis, Ind. 


J. L. Corbin, M. D., Athens, Penn. 

D. B. Whittier, M. D., Fitchburg, Mass. 

W. B. Chamberlain, M. D., Worcester, Mass. 

Wallace McGeorge, M. D., Woodbury, K". J. 


H. C. Allen, M. D., Ann Arbor, Mich. 
Elias Yernon, M. D., Hamilton, Canada. 


* — 

H. F. Biggar, M. D., Cleveland, Ohio. 


Nominees for the Regents' Degree. 221 


^Frederick F. Stamm, Brooklyn. 

*M. M. Matthews, Rochester. 


Alfred W. Gray, Milwaukee, Wis. 
Caspar Bruchhausen, Norwich. 
William B. Reeve, Quogue. 

*Constantine Hering, Philadelphia, Penn. 

*John F. Gray, New York. 


*Carroll Dunham, Irvington. *H. V. Miller, Syracuse. 

William EL Watson, Utica. William Gulick, Watkins. 


Egbert Guernsey, New York. E. P. Fowler, New York. 
Charles Sumner, Rochester. *C. Ormes, Jamestown. 


A. W. Holden, Glens Falls. L. M. Pratt, Albauy. 

Asa S. Couch, Fredonia. Edward Bayard, New York. 


A. R. Wright, Buffalo. Henry Minton, Brooklyn. 

O. Groom, Horseheads. W. C. Doane, Syracuse. 


H. M. Paine, Albany. A. S. Ball, New York. 

E. H. Hurd, Rochester. C. T. Harris, Syracuse. 


Chas. E. Swift, Auburn. E. Darwin Jones, Albany. 


John W. Dowling, New York. *L. M. Kenyon, Buffalo. 

R. C. Moffat, Brooklyn. John J. Mitchell, NewburgU. 

222 Senior and Permanent Members. 

S. Powell Burdick, Oakland, Cal. Timothy F. Allen, New York. 


Samuel Lilienthal, Cal. Everitt Hasbrouck, Brooklyn. 

*Titus L. Brown, Binghamton. Edward S. Coburn, Troy. 

i 1887. 

Wm. Tod Helmuth, New York. Henry C. Houghton, New York. 



1863. R 0. Moffat, M. D., Brooklyn. 
1865. Wm Gulick, M. D., Watkins. 


1864. E. Darwin Jones, M. D., Albany, 
1864. L. M. Pratt, M. D., Albany. 


1864. L. B. Wells, M. D., Utica. 

1863. A. S. Ball, M. D., New York. 

1864. D. H. Bullard, M. D., Glens Falls. 



Adriance, F. W Elmira, 1883 

Allen, George Water ville, 1883 

Allen, T. F 10 E. 36th Street, New York, 1879 

Armstrong, T. S Binghamton, 1883 

Atwood, J. Freeman 307 Cumberland St., Brooklyn, 1883 

Bacon, Chas. A 130 E. 35th Street, New York, 1879 

Baker, C. C Batavia, 1873 

Banker, Jb\ A Bhinebeck, 1887 

Barnard, J. F Clyde, 1886 

Barnes, W. H Chatham, 1872 

Baylies, B. L' B 358 Hancock St., Brooklyn, 1883 

> -hi ■■ rir~ 

Permanknt Members. 223 


Beach, Eliza J Waverly, 1875 

Belcher, George E 522 Madison Ave., New York, 1868 

Benson, E. F Troy, 1886 

Biegler, J. A 58 S. Clinton Street, Rochester, 1879, 

Billings, G. H Cohoes, 1875 

Birdsall, S. T Glens Falls, 1883 

Bishop, E. 8 Medina, 1867 

Bonnell, Chas. L 3 Hanson Place, Brooklyn, 1879 

Boocock, Eobert Flatbush, ' 1883 

Borden, G. T Caledonia, 1887 

Boyce, C. W Auburn, 1863 

Bradner, Ira S Middletown, 1876 

Brainard, L. L Little Falls, 1883 

Brayton, S. N 202 Delaware Ave., Buffalo, 1886 

Brown, E. V Tarrytown, 1886 

Brown, W. B Palmyra, 1871 

Bryan, E. W Corning, 1880 

Bull, L. A 160 Franklin Street, Buffalo, 1886 

Burdick, S. Powell Oakland, Cal. 1874 

Butler, W. M 507 Clinton Ave., Brooklyn, 1881 

Calkins, T. T Hudson, 1868 

Campbell, Alice B 114 S. 3d Street, Brooklyn, E.D., 1882 

Campbell, C. E Elmira, 1886 

Candee, J. W 76 Warren Street, Syracuse, 18S5 

Carr, Allen B 89 N. Clinton Street, Eochester, 1883 

Carroll; S. H 228 State Street, Albany, 1874 

Case, W. E Poughkeepsie, 1886 

Chamberlain, Jos. H Belfast, 1887 

Chapin, Edward 352 Clinton Street, Brooklyn, 1883 

Chase, C. E 134^ Park Ave., Utica, 1882 

Clark, A. J Bingharaton, 1883 

Clark, L. A Loveland, Larimer Co., Col., 1S79 

Coburn, Edward S 91 Fourth Street, Troy, 1874 

Coffin, H. W 415 West 47th Street,New York, 1883 

Cole, Directus D Morrisville, 1883 

Collins, N. M 43 East Ave., Eochester, 1886 

Cook, C. P Hudson, 1872 

Cook, Joseph W 138 Delaware Avenue, Buffalo, 1883 

Cornell, C. W 343 W. 29th Street, New York, 1884 

Couch, Asa S Fredonia, 1864 

Covert, N. B Geneva, 1878 

224 Permanent Members. 


Cowl, Walter Y 162 W. 34th St., New York 1883 

Cox, G. A 80 So. Swan St., Albany, 1878 

Cox, J. W 109 State St., Albany, 1869 

Crandall, E. L Troy, 1885 

Curtiss, Alexander M 334 Pearl St., Buffalo, 1883 

Day foot, Herbert M 41 Sophia St., Rochester, 1881 

Decker, Wm. M Kingston, 1883 

Dods, A. Wilson Fredonia, 1883 

Doolittle, Jas. F Ballston Spa, 1883 

Doughty, F. E. . .^ 512 Madison Ave., New York, 1877 

Dowling, J. W. * 313 Madison Ave., New York, 1873 

Dutcher, Merritt T Owego, 1884 

Eddy, Ermina C Elmira, 1883 

Elliott, J. B 493 Clinton Ave., Brooklyn, 1878 

Everitt, Daniel L 39 Madison St., Brooklyn, 1867 

Fancher, Edwin Middletown, 1885 

Faust, Louis Schenectady, - 1885 

Fiske, Wm. M. L 12 Bedford Ave., Brooklyn,E.D.,l875 

Fowler, Win. P 63 So. Clinton St., Rochester, 1876 

French, W. W Ballston Spa, 1883 

Frve, Moses M Auburn. 1884 

Fulford, G. H Henderson, 1883 

Fuller, Hiram E Lansingburgh, 1885 

Fulton, Fred S Ill E. 70th St., New York, 1887 

Gallup, M. W Saugerties, 1883 

Gamman, A. M Corning, 1886 

Gifford, Barton R Madison, 1883 

Gifford, G. A Clayville, 1875 

Gifford, G. L Hamilton, 1868 

Gifford, W. B Attica, 1886 

Goewey, Catherine E 213 Hamilton "St., Albany, 1880 

Gorham, Geo. E 160 Hamilton St., Albany, 1883 

Grant, B. F Bath, 1874 

Groves, C. A Ticonderoga, 1886 

Greenleaf, J. T Owego, 1884 

Guernsey, Egbert 526 Fifth Ave., New York, 1865 

Guy, C. N Maine, 1885 

Hale, C. D 53 Warren St., Syracuse, 1883 

Hallock, Lewis 34 E. 39th St., New York, 1867 

Hand, George F Binghamton, 1884 

Hasbrouck, E 369 9th St., Brooklyn, J873 

Permanent Membeks. 


Hasbrouck, Sayer Providence, R. I., 

Hathaway, W. E Hornelleville, 

Haviland, N. H Fulton, 

Helrauth, William Tod 299 Madison Ave., New York, 

Heinemann, J. D 77 E. Eagle St., Buffalo, 

Hill, C. Jadson Utica, 

Holden, A. W Glens Falls, 

Houghton, B. L Greene, 

Houghton, Henry C 12 "W. 39th St., New York, 

Hulst,P. H Greenwich, 

Hunt, D. B 44 "West 29th St., New York, 

Hunting, Nelson 155 Hamilton St., Albauy, 

Hurd, E. H 41 Sophia St., Rochester, 

Hutchine; H. S Batavia, 

Jeffrey, George C 341 Tompkins Ave., Brooklyn, 

Jones, Charles E 140 State St., Albany, 

Keeney, J. H Oswego, 

Kellogg, E. M . . . . 134 E. 36th St., New York, 

Kenyon, W. B S6 W. Mohawk St., Buffalo, 

King, George H Geneva, 

King, W. H 23 W. 53rd St., New York, 

Kinne. A. B 29 E. Jefferson St., Syracuse, 

Kinney, C. Spencer Middletown, 

Knapp, Theodore P Union, 

Knickerbocker, S. C Watertown, 

Laird, F. F Utiea, 

Laird, W. T Watertown, 

Latimer, Wm. C 410J Clinton PI., Brooklyn, 

Lee, J. M 89 Plymouth Ave., Rochester, 

Lewis, F. Park 188 Franklin St., Buffalo, 

Lewis, G. W 311 Delaware Ave., Buffalo, 

Lilienthal, S , Cal. 

Linendall, Robert A Fort Edward, 

Little, G. W Glens Falls, 

Long, William E 187 15th St., Buffalo, 

Low, C. E Plattsburg, 

Lozier, Clemence S 103 W. 4Sth St., New York, 

McKinney, Susan S 178 Ryerson St., Brooklyn, 

McKown, J. F Hamilton St., Albany, 

McManus, G. D Oswego, 

McMurray, Robert 234 Second Ave., New York, 

226 Permanent Membebs, 


McPherson, J. C Lyons, 1883 

Milbank, W. E Ill State St., Albany, 1879 

Miller, E. E Oxford, 1871 

Millspaugh. 0. F Binghamton, 1883 

Minton, Henry 165 Joralemon St., Brooklyn, 1864 

Mitchell, J. J Newburgh, 1880 

Moffat, John L 17 Schermerhorn St., Brooklyn 1883 

Moore, J. de Velio Utica, • 1887 

Morgan, A. R New York, 1866 

Mosher, Charles M Easton, 1863 

Mull, P. W Ghent, 1876 

Nash, E. B Cortland, 1885 

Noble, G. Z Dundee, 1884 

Norton, Arthur B 167 W. 34th St., New York, 1886 

Norton, George S 154 W. 34th St., New York, 1884 

Osborne, N 73 W. Eagle St., Buffalo, 1879 

Ostrom, Homer 1 42 W. 48th St., New York, 1886 

Otis, Clark Penn Yan, 1883 

Otis, John C Ponghkeepsie, 1883 

Paine, Henry D 136 Madison Ave., New York, 1863 

Paine, Horace M 105 State St., Albany, 1864 

Palmer, George B East Hamilton, 1867 

Pearsall, John A Saratoga Springs, 1882 

Pearsall, S. J Saratoga Springs, 1866 

Peckham, J. J 123 N. Pearl St., Albany, 1881 

Perrine, W. L. R *37 Montague St., Brooklyn, 1876 

Peterson, O. W . , . . Waterloo, 1884 

Preston, H. G 138 S. Oxford St., Brooklyn, 1875 

Pritchard, G. C Phelps, 1882 

Proctor, W. H Binghamton, 1884 

Purdy, Mark S Corning, 1887 

Radway, C. W Mexico, 1885 

Rogers, E. W Crystal Springs, 1879 

Schenck, H. D 247 McDonough St., Brooklyn, 1887 

Searle, W. S 132 Henry St., Brooklyn, 1865 

Seegar, Ferdinand 718 Lexington Ave., New York, 1887 

Seeley, N. R Elmira, 1871 

Seeley, William W 300 Lark Street, Albany, 1886 

Seymour, G. W Westfield, 1883 

Shafer, Levi Kingston, 1874 

Shaw, J. C Hoosick Falls, 1885 

•'Jt *v 

. ■ if * 



•J . 

. -Cfifi 
• ^ 

Permanent Membebs. Qjft -'^M 

' Elected, . ' S3 

Sheldon, Jay W 76 Warren St., Syracuse, 1885 |^ 

Shelton, George G 10 E. 36th St., New York, 1886 .^f 

Simmons, D 97 Lee Ave., Brooklyn, 1884 

Simmons, Silas S Snsquehanna, Pa., 1885 

Skinner, Scott W Le Roy, 1887 

Slaught, J. E Hamilton, 1883 

Smith, Henry M 5th Ave.. Cor. 13th St., 1865 * 

Smith, Oran W Union Springs, 1884 

Smith, T. Franklin 2064 6th Ave., New York, 1871 

Snyder, E. E * Binghamton, 1883 

South wick, A. B Rome, 1871 

South wick, D. E Ogdensburg, 1867 

Spencer, Thomas D 61 South Union, Rochester, 1884 

Spoor, D. E Schenectady, 1883 

Stebbins, J. H • Geneva, 1871 

Stiles, S. E 51 Greene Ave., Brooklyn, 1880 

Stiles, Henry R Tenafly, N. J., 1885 

Stobbs, Alex. V Mecklenburg, 1883 

Strong, Thos. M Ward's Island, 1886 v 

Stumpf, D. B 311 Elliott St., Buffalo, 1885 

Sullivan, R. B 201 Madison Ave., Albany, 1884 

Sumner, Charles \31 S. Clinton Street, Rochester, 1873 

Sumner, Charles R 31 S. Clinton Street, Rochester, 1882 

Swift, C. E Auburn, 1870 

Talcott, Selden H Middletown, 1874 

Terry, M. O 196 Genesee Street, Utica, 1876 

Thorn, Sarah Eddy Catlin, 1884 

Throop, A. P Port Gibson, 1874 

Tilden, John M Peekskill, 1 883 

Tracy, G. A Logan, 1883 

Truman, Irving P Belmont, 1884 

VanCleef, C. E Ithaca, 1883 

Van Denburg, M. W Fort Edward, 1887 

Vincent, F. L 47 2d Street, Troy, 1873 

Voak, J. B Canandaigua, 1879 

Von der Liihe, A 296 S. 5th Street, Brooklyn, E. D.,1883 

Waldo, H. L West Troy, 1879 

Walker, Catherine Fredonia, 1886 

Walker, Charles E West Henrietta, 1887 

Watson, William H Utica, 1866 

Welch, C. Durant Albany, 1883 

92$ Permanent and Delegat* Members. 

/ Elected. 

Wellman, W. I Friendship, 1879 

West, James A Geneseo, 1883 

White, J. Ralsey E. 128th St., New York, 1863 ; 

White, Sue A 221 Genesee Street, Utica, 1883 

White, T. C 44 S. Clinton Street, Kochester, 1872 

White, Wm. Hanford 353 Fifth Avenue, New York, 1881 

Whitney, E. J 100 Lafayette Ave., Brooklyn, 1875 

Wiloox, DeWitt G 138 Delaware Ave., 1887 

Williamson, A. P Middletown, 1885 

Williamson, B. F Friendship, 1880 

Willis, Harrison 695 Lafayette Ave., Brooklyn, 1877 

Winterburn, George W 29 W. 26th Street, New York, 1885 

Wolcott, E. H 96 East Avenne, Rochester, 1886 j 

Wright, A. E 1 66 Franklin Street, Buffalo, 1863 

Wright, Francis M Waverly, 1885 

Zoller, William Fort Plain, 1883 j 

Zwetsch, J. D Gowanda, 1883 j 


N. B. Each County Society will elect ail of its delegates together 
for a term of four years. 

Class I. 

Terms expire at the close of the annual meeting, February, 188&. * \ 

New York County, 24. — Drs. P. E Arcularius, 57 East 21st Street i 

C. E. Beebe, 21 West 37th Street. 
F. H. Boynton, 30 West 33d Street. 
Edmund Carleton, 58 West 9th Street. 
L. L. Danforth, 159 West 44th Street. 
H. M. Dearborn, 152 West 57th Street. 
Geo. M. Dillow, 102 West 43d Street. 

D. B. Hunt, 44 West 29th Street. 
Malcolm Leal, 52d Street and Broadway. 
C. S. Macy, 117 West 12th Street. 
J. H. McDougal, Tompkinsville, L. I. 

E. V. Moffat, 132 West 44th Street. 
N. A. Mosinan, 350 Madison Avenue. 

Delegate Members. 229 

^New York County Continued. — *W. E. Rounds, 34 West 36th Street. 

* J. M. Schley, 1 East 42d Street. 
St. Clair.Smith, 8 West 38th Street. 
C. F. Sterling, Detroit, Mich. 
John H. Thompson, 36 East 30th Street. 
S. H. Vehslage, 313 East 18th Street. 
Edwin West, 111 Washington Place 
J. McE. Wetmore, 41 East 29th Street. 
S. F. Wilcox, 57th Street and Broadway. 

Hahnemann Hospital, 1. — Roger H. Lyon, Esq., 170 Broadway. 

New York Medical College and Hospital for Women, 1 . — Amelia 
Wright, M. D., 221 West 34th Street. 

Class II. 

Terms eocpire at the close of the annual meeting, 1889. 

Albany County, 4. — *Drs. C. E. Goewey, 213 Hamilton St., Albany 

*G. E. Gorham, 160 Hamilton, St., Albany 
*J. J. Peckham,123 N. Pearl St., Albany 

Allegany County, 1. — *Dr. B. F. Williamson, Friendship. 

Broome County, 1. — *Dr. G. F. Hand, Binghamton. 

Cayuga County, 2. — Drs. W. H. Curtis, Owasco. 

F. E. Murphy, [Hyatt] Auburn. 

Chautauqua and Cattaraugus Counties, 4. 

Drs. C. P. Ailing, Bradford, Pa. D. G. Ailing, Dunkirk. 
M. J. Lincoln, Olean. A. B. Rice, Panama, 

Chemung County, 1. — Dr. O. Groom, Horseheads. 

Chenango County, 1. — Dr. S. J. Fulton, Norwich. 

Columbia County, 1. — Dr. S. E. Calkins, Athens. 

Dutchess County, 2. — *Drs. W. R. Case, Poughkeepsie. 

*Anna C. Howland, Poughkeepsie. 

Erie County, 5. — Drs. H. Baethig, 350 Pennsylvania Street, Buffalo. 

H. E. Colton, 362 Pearl Street, Buffalo. - 
*J. D. C. Heinemann, 77 E. Eagle St., Buffalo. 
*W. B. Kenyon, 86, W. Mohawk, St., Buffalo. 
*N. Osborne, 73 W. Eagle Street, Buffalo. 

Livingston County, 1. — Dr. W. W. Russell, Livonia Station. 

230 Delegate Members. 

Madison County, 1.*— Dr. W. E. Deuel, Chittenango. 

Monroe County, 3. — Drs. W. E. Graham, Brockport. 

C. E. Walker, West Henrietta. 

*E. H. Wolcott, 96 East Ave., Rochester. 

Montgomery County, 1. — *Dr. Wm. Zoller, Fort Plain. 

Class III. 

Terms expire at the close of the annual meeting, February, 1890. 

Kings County,12 (Brooklyn). — 

Drs. W. W. Blackman, 88 So. Oxford Street. 
*Gertrude G. Bishop, 310 Throop Avenue. 
J. Albro Eaton, 123 Clymer Street, E. D. 
S. Eden, 91 Tompkins Avenue. 

D. A. Gorton, 137 Clinton Street. 
Helene S. Lassen, 96 Henry Street. 

Wm. E. McCune, 109 Cumberland Street. 
George Nichols, 230 Leonard Street. 
A. J. Palmer, 463 Bedford Avenue. 

E. H. Spooner, 776 DeKalb Avenue. 
S. Talmage, 22 Schermerhorn Street. 
R. K. Valentine, 65 Greene Avenue. 

Niagara and Orleans Counties, 3. — 

Oneida County, 3. — 

Onondaga County, 3. — 

Ontario and Tates Counties, 2. — 

Orange County, 2. — Drs. J. W. Ostrom, Goshen. 

fC. M. Lawrence, Port Jervis. 

Oswego County, 2. — 

♦Permanent Members. 

tDeceased. . .^jg 

• • ' • • •.- *■* 


Delegate Members. 231 


Class IV. ♦'.'I 

.J A 

> 'i 

Terms expire at the close of the annual meeting \ February, 1691. £ 

Otseoo County. 

Queens County. — No organization. 

Rensselaer County. 

Saratoga County 

Schuyler County. 

Seneca County. 

Steuben County. 

St. Lawrence County. 

Tompkins County. 

Ulster County. 

Warren and Washington Counties. — No organization. 

Wayne County, 2. — Drs D. McPherson, Palmyra. 

W. H. Sweeting, Savannah. 

Westchester County, 3. — Drs. Joseph Hasbrouck, Dobb's Ferry. 

T. C. Fanning, Tarrytown. 


4< tl < t 

(< ft It 

Address by President Houghton, ------ 

44 " M Paine, 

Albuminuria of pregnancy —causation, W. W. Blackman, M. D., 

effects of, Wm A Allen, M. D., 
44 " " therapeutics of, Geo. W. Winterburn, M. D., 

Allen, Geo., M. D., cases of mammary tumors, - 

peroxide of hydrogen in the treatment of abscess, 
the purification of water, - 
Allen, Wm. A , M. D., effects of the albuminuria of pregnancy, » - 
An improved membrana tympani, Sayev Hasbrouck, M. D., 
Announcement of committees, - 

A perplexing case of parturition, R. C. Moffat, M. D., 
A plea for the total extirpation of the cancerous uterus under conditions, A. R. 

Wright, M. D., 
Appointment of censors, ------- 

A practical modification of Valsalva's experiment, Henry C. Houghton, M. D. 

Auditing, committee on, - 

Aural mucous polypi, Chas C. Boyle, M D., - 

Ball, A S., M. D., placed on list of senior members, 

• remarks by, - - - - 

Beldin, C. A., M. D., remarks by, - 

Biggar, Prof. H. F., M. D., Caesarian section, - 

Boocock, Robert, M. D., resolutions offered by, - 

remarks on single remedy, 
wiring the patella, 
41 •« " " by, 

Boyle, Chas. C, M. D., aural mucous polypi, - 

" " " " curative effects of gelsemium in disease of the uveal 

tract, ------ 

Bromine as an antidote for dissecting and septic wounds, M. O. Terry, M. D., 

Brown, Rev. J. W., D. D., prayer offered by, 

Bull, L. A., M. D., remarks by, -..-.. 

Bullard, D. H., M. D., placed on list of senior members, 

Butler, Wm. M., M. D., neurasthenia, - 

Caesarian section, H. F. Biggar, M. D., 

Censors appointment of, - 

1 * committee on, - - 

4 * report of board of, 
Chairman of bureaux, committee on, - - - _ _ 

Clark, Chas. G., M. D., biographical sketch of , - 
Note. — Part II. is so indicated. Pages of Part I. have no prefix. 

I t II II 

II II tl- <i (I 
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- II 






- II 




- II 




- II 




















II 39- 




- II 




- II 




- II 




- II 




















Index. 333 

Climatology report of the bureau of , - - - - II 173 

Clinical tests of potencies, resolution adopted by committee on, - 20 
Collation given by New York County Society to State Homoeopathic Medical 

Society, _-..-..- II 19 

Committees announcement of, ------ - 28 

Committee of arrangements, local — appointment of for semi annual meeting, 51 

44 on chairman of bureaux, report of, 51 

44 " legislation, report of , ------ 31 

14 ' 4 President's address, report of, - - - 18,46 

44 •• 4t resolution offered by, - II 8 

14 4f regents' degree, report of, 49 

44 '* tests of high attenuations, report of, - 48 

Communication from Pennsylvania State Society, - 20 

44 Drs. Helmuth, Dowling and Hills, '- - - II 4 
Complications of parturition — pelvic dystocia and methods of delivery, H. J. 

Pierron, M. D., - - - - - II 54 

Constitution and By Laws, - - - - - - II 205 

Cowl, Walter, Y., M. D., the suspension of the clothing, - - II 66 

Credentials, committee on, - - - - - - 3, 28 II 3 

" report of committee on, - - - 3 

Curative effects of gelsemium in disease of the uveal tract, Chas. C Boyle, M.D , II 129 

De ad y, Ch as., M. D., remarks by, ...... II 139 

44 44 4t spectacles, ...... II 125 

Deceased permanent members, - - - - -II213 

Delegates, report of, ...... 47 

Delegate, members, - - - - - - - -II 228 

Department of necrology, - - - - - - - II183 

Diplopia, a clinical case, John L. Moffat, M, D., - - - II 136 

Dods, A. Wilson, H, D., microscopic anatomy of the carcinomata, - - II 178 

Election of officers, -------- 50 

Experience in the management and treatment of neurasthenia, George E. Gorfcam, 

M. D., II 162 

Extracts from case book, E. H. Linnell, M. D., - - - II 131 

Gilchrist, J. G. M. D., radical cure for hernia, - - - II 97 
Gorham, Geo. E., M. D., experience in the management and treatment of 

neurasthenia, - - - - - II 162 

44 44 * 4 remarks on the single remedy, - II 39 

Gynaecology report of the bureau of, - - - - II 66 

Hahnemann's writings and rubrick, M. W. VanDenburgh. M. D., - II 30 

Hasbrouck, E., M. D., remarks on death of Dr. Brown, - - II 20 

44 44 44 €4 monotropa, ... - II 39 

Hasbrouck, Sayer, M. D., 44 lt spectacles, - - - - II 139 

44 44 4I 44 gelsemiutn, .... II 140 

44 * 4 t4 an improved membrana tympani, - - II 143 

44 4I " remarks by, - - II 147, 149 

Helmuth, Wm. Tod, M. D., nominated for regents' degree, - - - 51 

Histology report of the bureau of, - - - - - II 178 

Holden, A. W., M. D., report of, as necrologist, .... 47 

Hollet, Arthur P., M. D., biographical sketch of, - - II 189 

Honorary members, -------- II 218 


ti It 


• • l« 

334 Index. 

Houghton, Henry C, M. D., address by president, - 5. 22 
" " " a practical modification of Valsalva's experiment, II 141, 

*' " *' nominated for regents' degree, - 51. 

remarks by, - - - 3, II 148 

" " ** resolution offered by, - - - II ig 

" i# ,# vote of thanks tendered, . - - - 17 

Howland, Anna C, M. D., report of as delegate, ... 47 

" " " resignation of, - 49 

In memorium, .....-.- \{ 213 

Invitations, committee on, - - - - - - - 28 

Kenyom, L. M., M. D., biographical sketch of, - - - - II . 191 

King, Wm H.,M. D , treatment of fibroid tumors by elect olysis, - - II 93 
Knight, S. H., M. D., remarks on the before and after treatment of laparotomy, II 123 

Laryngology, report of the bureau of , - - - - -II 167 

Leal Malcolm, M. D , on conditions of the larynx requiring local treatment, II 169 

Lee, J. M., M. D., remarks on lycopodium, - - - - II 119 

antiseptics, ... - - -11121,123,124. 

** before and after treatment of laparotomy - - II 122 • 

supra-pubic cystotomy (clinical) - - - - II 89 

Legislation, report of committee on, - - - - - -19, 31 

Linnell, E. H., M. D. , extracts from case-book, - - - II i3 r 

remarks by, - II 140 

List of permanent members - - - - - - II 222 

Local treatment of laryngeal, pharyngeal and nasal tuberculosis, 

J. M Schley, M. D., - - - - - - II 167 

Mammary tumor — was it scirrhous? R. C. Moffat, M. D., - - II 80 

Marasmus infantum, Susan S. McKinncy, M. D., - - - - II 150 

Materia medica, report of the bureau of, . - - - - - II 22 

McKinney, Susan S., M. D., marasmus infantum, - - - -II 150 

M c Murray, Robert M. P., remarks by, - - - - - II 39 

Medical legislation, report of committee on, - - - - - 1 1 8 

Medical bill, ... II 9 

Medium of drug action, B. S. Partridge, M. D., - - - - - II 26 

Members, list of permanent, - - - - - - - II 222 

Membership, applications for, - - - - - - 20 II 20 

Mental and nervous diseases, report of the bureau of, - - - - II 152 

Microscopic anatomy of the carcinomata, A. Wilson Dods, M. D., - II 178 

Moffat, John L., M. D., diplopia, a clinical case, - - - - II 13° 

remarks on drug action, - - - - II 39 

14 single remedy, - - - - II 30 

Moffat, R. C, M. D., mammary tumor — was it scirrhous ? - II 80 

Necrologist, report of, A. W. H olden, M. D. f - - - - 47 

Necrology, department of, - - ... - II 183 

Neurasthenia, William M. Butler, M. D., - - - - - - II 153 

Neurasthenia and melancholia, Selden H. Talcott, M. D., - - - II 159 

Nomination of candidates for regents' degree, - - - 51, II 221 

Norton, A. B., M. D., remarks on colocynth, - - - II 138 

" gelsemium, II 139 

' Politzer's inflator, II 147 

" u " " " spectacles, II 139 

Nottingham. J. C, M. D., delegate from Michigan, ... ,3. 

11 11 11 11 

II « •« t* II i< 



1 1 






Observations on the medical and surgical treatment of tumors and cancers of the 

breast, M. O. Terry. M. D. f 
Obstetrics, report of the bureau of, 
Officers, --------- 50, 

On conditions of the larynx requiring local treatment, Malcolm Leal, M. D., 

Ophthalmology, report of the bureau of, 

Ormes, Cornelius, M. D., biographical sketch of, 

Ostrom, H. T., M. D., the before and after treatment of laparotomy, 

the treatment of the pedicle in hysterotomy, 

remarks on antiseptics, - 
Otology, report of the bureau of, ----- - 

Paedology, report of the bureau of, - - - 

Paine. H. M., M. D., biographical sketch of, - 

Partridge, B. S., M. D., the medium of drug action, 

Permanent and honorary members, ------ 

Permanent members, list of. 

Peroxide of hydrogen in the treatment of abscess, George Allen, M. D., 

Pettit, T. J., M. D., biographical sketch of, - - 

Philip, Jacob S., M. D., biographical sketch of, - 

Pierron, H. J., M. D., complications of parturition, - 

Pratt, O. E., M. D., resignation of, 

President's address, committee on, 

President's address, report of committee on, - - - - - 

Radical cure for hernia, J. G. Gilchrist, M. D., - - - II 

Randel, Wm. Henry, M. D., biographical sketch of , - - - -II 

Regents' degree, committee on ------ 

nomination of candidates for, 

report of committee on, - 

Reports (vide respective subjects*, 
Resignation of Anna C. Howland, M. D., - - - - - 

•• O. E. Pratt, M. D., - 

Resolutions adopted by committee on clinical tests of potencies 
received from New York and Kings Counties, 













Schley, J. M., M. D., local treatment of laryngeal, pharyngeal, and nasal 

tuberculosis, - - - - - II 

'• M " remarks by. - II 

Selection of time and place for semi-annual meeting, - 

Semi-annual meeting at Niagara Falls, - 

Senior members, L. B. Wells, M. D , placed on list of, - 

A. S. Ball, M. D., " 

D. H. Bullard, M. D., 
Shelton, George G., M. D., remarks by, ----- II 

Smith, Henry M., M D., remarks on single remedy, - - - II 

Spectacles, Charles Deady M. D. - - - - II 

Statement issued by committee on legislation, - - - - - 

Strong, T. M., M. D., remarks by, II 

Supra-pubic cystotomy (clinical), J. M. Lee, M. D., - - - - II 

Surgery, report of the bureau of, - - - - - - II 

Suspension of the clothing, Walter Y. Cowl, M. D., - - - - II 






















1 67 















• I 

















Talcott, Selden H., M. D., neurasthenia and melancholia, - II 

Telegram to Pennsylvania Homoeopathic Medical Society, - - II 

received from •• " I[ 

Terry, M. O., M. D., resolution offered by, - - - - - II 

remarks by, - - - - II 143, 172 

observations on the medical and surgical treatment of 

tumors and cancers of the breast, - - - 1 1 

bromine as an antidote for dissecting and septic wounds, II 
Tests of high attenuations, report of committee on, - - 

Thanks, vote of, tendered Dr. Paine, - - 

Thanks, vote of, tendered proprietors of Cataract House, - 

President Houghton, - 

Secretary H. M. Day foot, 

Members ot the common council of the city of Albany 
New York County Horn Med. Society, - II 

The before and after treatment of laparotomy, H. I. Ostrom, M. D , - II 

The indicated remedy, E. H. Wolcott. M. D., - - - - II 

The single remedy, " " " II 

The suspension of the clothing, Walter Y. Cowl, M. D., - II 

The treatment of the pedicle in hysterotomy, H. I. Ostrom, M. D., - - II 

Thirty-sixth annual meeting, proceedings of, - 

Transactions, set of granted Hahn. Society of Horn. Med. College, New York, - 
Treasurer, report of, - - 

Treatment of fibroid tumors by electrolysis— Dr. Apostoli's method, William H. 

King, M.D., - - - - - - - II 

Van Denburg, M. W., M. D., Hahnemann's writings and rubrick - - II 

remarks on colocynth, - - II 

lyco] odium, - - - II 

single remedy, - II 

Vote of thanks tendered Dr. Paine, ------ 

" " " Proprietors Cataract House, 

President Houghton, - 

Secretary H. M. Dayfoot, - 

Members common council of city of Albany, 

New York County Horn. Med. Society, - II 

Wells, L. B., M. D., placed on list of senior members, - 
Wilcox, Sidney F., M. D., wiring the patella, - - - - II 

44 44 " remarks on radical cure for hernia, - - II 

41 " " " wiring the patella, II 

antiseptics, - - - - II 

the before and after treatment of laparotomy, II 
Winterburn, Geo. W., M. D., Albuminuria of, pregnancy — the therapeutics of, II 
Wiring the patella Sidney F. Wilcox, M. D., - - - - II 

Wolcott, E. H.,M. D., the indicated remedy, - - - II 

" *' " the single remedy, - - - - - II 

Wright, A. R., M. D., a plea for the total extirpation of the cancerous uterus 

under conditions, - - - - - - - - II 70 





























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